Welcome to RSNA Weekly
Welcome to RSNA’s newest method of providing you the information that you need to know—this is the premiere issue of RSNA Weekly.
RSNA Weekly provides you with a review of key issues affecting our profession. It will be delivered directly to you by e-mail and posted on RSNA.org.
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Theresa C. McLoud, M.D.
2008 RSNA President
Headlines
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
Leading the News
Researchers See Promise in New Test for Tumors
Associated Press (09/04/08)
Researchers at the Mayo Clinic in Rochester, Minn. have developed an experimental method for detecting breast cancer that finds more tumors in dense breasts and gives fewer false alarms than other methods. As part of the new method, known as molecular breast imaging (MBI), doctors intravenously administer a radioactive tracer that is absorbed more by cancerous cell than healthy tissue. As a result, the tumors put off a "glow" that allows doctors to more easily spot them in women with a large amount of dense breast tissue. In tests on women who had dense breasts and a high risk of cancer because of factors such as family history, MBI found 10 of the 13 tumors that were found in 12 of the 940 participants. By comparison, mammograms detected 3 of the tumors. In addition, researchers also found that MBI produced false alarms in 7 percent of the patients, compared with 9 percent for mammograms. However, MBI uses about 8 to 10 times the radiation that mammograms use, a dose that engineers at the Mayo Clinic are trying to reduce with the help of new technology. More studies of MBI are on the way, including a study sponsored by the federal government that will compare the technology with magnetic resonance imaging (MRI).
Research
PET Scans May Help Assess Presence of Brain Plaques Related to Alzheimer's Disease
Science Daily (08/12/08)
Positron emission technology (PET) scanning may be able to detect the formation of beta-amyloid plaques in the brain, according to University of Kuopio Prof. Ville Leinonen and his colleagues. Their work, reported in the October issue of the Archives of Neurology, involved 10 patients who had undergone a frontal cortex biopsy because they were suspected of having normal-pressure hydrocephalus. Of those patients, six had beta-amyloid plaques in their tissue samples, while four displayed no Alzheimer's disease-related brain changes. The patients were then injected with a carbon 11-labeled Pittsburgh Compound B ([11C]PiB) marker and underwent a 90-minute PET scan. Scan results showed that patients who had beta-amyloid plaques in their brain biopsy also displaced a higher uptake of [11C]PiB in certain brain areas. The researchers are hopeful that [11C]PiB PET could become a successful diagnostic tool for Alzheimer's disease.
Can Low-Dose Radiation Increase Risk of Cardiovascular Disease?
Lancet (09/05/08) Vol. 372, No. 9640, P. 697; Bhatti, Parveen; Sigurdson, Alice J.; Mabuchi, Kiyohiko
Research shows that risk of heart disease increases after high-dose therapeutic radiation. Yet, researchers are unsure if unexpected cardiovascular effects may also be present at subtherapeutic doses, such as those used for non-malignant disease or repeated diagnostic procedures. To determine the long-term cardiovascular effects of low-dose radiation, Dave McGeoghegan and his team conducted an analysis of non-cancerous health conditions in 65,000 employees of British Nuclear Fuels in the United Kingdom. The researchers found a significant association between circulatory disease and exposure to external radiation. However, proving a causal association between low-dose radiation and cardiovascular complications is difficult without an established biological model. Some researchers believe the cardiovascular disease risk detected at lower radiation dose levels could be associated with direct changes in the exposed cells. Still, further research is needed to discover the effects of radiation and confounders in existing and planned studies of radiation-exposed cohorts, as are laboratory studies to determine biological mechanisms for low-dose radiation-related cardiovascular effects.
Ultrasound Uses in Medicine Heat Up
Science (07/18/08) Vol. 321, No. 5887, P. 338
Researchers are exploring new ultrasound-based technologies that could be used to view the inner structure of bones and treat currently incurable cancers. Radiologists currently use X-rays to determine the average density of the bone, but that technology cannot offer insight into the quality of the bone. In contrast, ultrasound can offer doctors a view of a bone's inner structure. Although transmitting ultrasound through a bone is effective for longer bones, current technology is still unable to analyze the hip. Doctors are already using high-intensity focused ultrasound (HFIU) therapy to treat prostate and uterus cancers. The therapy involves focusing ultrasound beams on the center of the tumor, which dies as the waves are converted into heat. Although this process is widely used to treat cancer in easily accessible tissue, it has not been used on the brain because doctors have not been able to focus the beams through the skull. University of Paris medical researcher Mathias Fink believes that time-reversal acoustics, which use echo patterns to guide waves through a barrier, could be used to target brain tumors.
Technology
RFID, Radio Location Services Use Soaring at Hospitals, Study Shows
Network World (08/20/08) Cox, John
A study by Spyglass Consulting Group reveals that hospitals are aggressively expanding their use of passive and active radio-frequency identification (RFID) systems in an effort to simplify and fix various health care workflows and business processes, among other things. Since the last Spyglass study was conducted three years ago, RFID-based applications have increased 300 percent, according to Spyglass founder and managing director Greg Malkary. Active RFID applications involve a radio embedded in a tag that can transmit a signal on its own, while passive RFID tags do not have a radio, relying instead on the reader's radio to activate the tags. RFID applications have progressed from such things as tracking infants and wheelchairs to tracking personnel, combined with time-motion studies to optimize workflows in areas such as radiology and surgical departments. "You can see where people are and figure out how they're spending their time," says Malkary. The 2005 Spyglass study determined that 90 percent of respondents were not willing to invest in wireless that did not utilize their existing wireless LAN or corporate backbones, an attitude that Malkary says has changed considerably since. RFID investments usually concentrate on department-level rather than hospital-wide challenges, while wirelessly compiled location data will probably emerge as a key component of the transition to hospital-wide electronic patient records. Potential advantages of hospital-wide, wireless location and identity data include better clinical outcomes, more efficient operations, and higher financial benefits in terms of cost savings, cost avoidance, and improved revenue.
Taming the Technology Beast
Journal of the American Medical Association (06/25/08) Vol. 299, No. 24, P. 2898; Berwick, Donald M.
The healthcare industry is constantly integrating new technologies to improve patient care, but some of these new technologies also introduce risks. An excellent example of this is a recent study that demonstrated how radio-frequency identification (RFID) technologies can cause dangerous electromagnetic interference (EMI) when in close proximity to medical devices. RFID systems either can be active, where they transmit a signal constantly to a reader device, or passive, when the tags are active only when an electromagnetic field is emitted by a reader. Scientists analyzed the effects of two RFID systems, one active and one passive, on 41 medical devices, including infusion pumps and external pacemakers. In a total of 123 tests, researchers found 34 EMI incidents, 26 caused by passive systems and eight caused by active systems. Twenty-two of those incidents were considered hazardous because they could pose a danger to the patient. In light of the findings, researchers urge hospitals to improve their surveillance of EMI effects, especially in critical care units. However, they note that there is no one solution that can completely mitigate the risks of any new technology. Organizations must continually update their risk management strategies to maximize safety and reliability.
Medical-Legal Issues
Florida Spends the Most on Medical Imaging Procedures in U.S.
Orlando Business Journal (09/01/08) Bandell, Brian; Bilbao, Richard
Medicare spending for medical imaging procedures reached $14.1 billion in 2006, twice what was spent in 2000. Florida's Medicare beneficiaries spent more for scans than in any other state, around $472 per enrollee. A U.S. Government Accountability Office report questioned whether primary care physicians and specialists with scanning equipment are profiting from their overuse. The report also recommended that Congress consider requiring pre-authorization for all imaging services, including X-rays, ultrasounds, and MRIs. Insurance industry experts blame the increased use of medical imaging equipment for high health insurance premiums. Congress is already considering legislation that would require all medical offices that bill Medicare for advanced imaging services to be accredited. Other legislation would require doctors to disclose to patients if they have a conflict of interest and offer patients a list of alternative imaging centers. The American Medical Association opposes the legislation because it could hurt practices that use their imaging equipment properly.
Medicaid Bears Brunt of States' Budget Crunch
Christian Science Monitor (08/15/08)
Facing budget deficits, two of the nation's most populous states, California and New York, are proposing changes in Medicaid that could affect the eligibility of hundreds of thousands of people or decrease funding for pharmacists, hospitals, and doctors. In July, California cut reimbursements to providers by 10 percent. With the legislature deadlocked over the budget, some healthcare facilities are now close to bankruptcy since no money is flowing to providers. As more states face falling tax revenues, there could be more cuts by this fall. "Medicaid is very much in jeopardy," says Iris Lav, deputy director at the Center on Budget and Policy Priorities in Washington. One in 5 Americans is covered by Medicaid. "This is a recurring problem states have during every recession," says Stephen Zuckerman, a healthcare economist at the Urban Institute in Washington. It might be difficult to get federal aid, says Dan Hawkins, policy director for the National Association of Community Health Centers in Washington. "There is good support for fiscal relief by several key members of Congress such as Rep. John Dingell (D-Mich.)," says Hawkins. "But it all depends on whether Congress does a second fiscal stimulus package, and that is looking increasingly doubtful with President Bush saying he would veto any more fiscal stimulus." When state lawmakers look at their budgets, the two largest expenditures are education and Medicaid. On average, states pay 43 percent of Medicaid costs, the rest picked up by Washington. "There is more flexibility in Medicaid than education," says Ann Kohler, director of the National Association of State Medicaid Directors in Washington. D.C. "You can define who to cover and how to set rates." The state of Maine recently added a $25 enrollment fee for adults for its Medicaid program, while other states, such as California and Arizona, are asking recipients to reenroll for benefits more frequently.
Clinical Practice
Making Practices Perfect
Washington Post (08/26/08) P. HE01; Kenen, Joanne
More doctors are reinventing their practices to maximize efficiency and lower overhead costs. According to Institute for Healthcare Improvement President Donald Berwick, most doctors are "practicing horse-and-buggy medicine in the space age," using outdated systems and methodologies that frustrate both patients and doctors. In response, many doctors have launched micro-practices that take advantage of technology to boost patient and provider satisfaction. Dr. Ramona Seidel operates Bay Crossing Family Medicine in Annapolis, Md., dividing the schedule with two other doctors and employing a single part-time office manager. Patients do not wait to see her, and she allows them to call or email at anytime. The micro-practice sends email reminders to patients and uses an electronic medical record system. Handling patients' concerns as they pop up minimizes off-hours calls; and unlike so-called "concierge practices," Seidel does not levy annual fees and accepts Medicare and other health plans. Anne Agnoni, a patient of Seidel's, notes, "It's a little more money, but she spent 30 or 45 minutes each with my older sons, and that was just the camp physical. I have to pay a $100 diagnostic fee just for my mechanic to look at my car, never mind repair it."
Online Doctors Make House Calls Again
Connecticut Post (CT) (08/22/08) Varnon, Rob
A recent study by the National Center for Policy Analysis indicates that telemedicine is gaining popularity, with more doctors treating patients via the Internet. Center analyst Devon Herrick says telemedicine could help people without insurance afford care, citing a 2001 report from the Center for Studying Health System Change revealing that 33 percent of patients encounter obstacles in visiting their primary care physicians. Services like TelaDoc charge a flat fee for a consult and hire licensed physicians to review medical histories and other information provided by patients over the phone; Herrick says such services could prevent expensive emergency room visits when people are on vacation, for instance. Supporters of telemedicine see benefits for patients in rural areas, and they believe technology could make it easier for doctors to manage chronic conditions, examine MRIs and X-rays, and consult with specialists in other areas. However, experts say telemedicine raises concerns about malpractice, jurisdiction, care quality, and security.
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