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Research
Technology
Medical-Legal Issues
Clinical Practice
Leading the News
Insurers Hire Radiology Police to Vet Scanning
The number of computed tomography scans and MRIs increased by 43 percent between 2002 and 2007, contributing to rising healthcare costs. Many large insurers have hired radiology benefits managers (RBMs) to ensure that they do not end up covering unnecessary scans. Guidelines are based on scientific evidence and the recommendations of medical groups, such as the American Society of Clinical Oncology. Most RBMs require doctors to obtain their permission for a test before an insurer will agree to cover the procedure. Doctors argue that the review process can result in significant delays or incorrect rejections that pose risks to patient health. There also are complaints that seeking permission is a waste of time because doctors are trying to justify their medical decisions with people who have not seen their patients. Specifically, practitioners have pointed out that delaying positron emission tomography scans can result in cancer going undetected until it is too late to treat the patient.
From "Insurers Hire Radiology Police to Vet Scanning"
Wall Street Journal (11/06/08) P. D1; Mathews, Anna Wilde
Research
MRI Eliminates Unnecessary Surgery for Children with Suspected Musculoskeletal Infections
For children with possible musculoskeletal infections, a pre-treatment MRI can reduce or eliminate unnecessary diagnostic or surgical procedures. At Vanderbilt Children's Hospital in Nashville, 130 children with suspected septic arthritis or osteomyelitis were observed, 34 of whom had an MRI after diagnostic or therapeutic intervention, and 96 of whom received an MRI before any treatment. According to the study's lead author Dr. J. Herman Kan, because about 60 percent of the patients did not have a musculoskeletal infection at all, early MRI evaluation could have prevented a majority of the diagnostic or surgical procedures. Also, Kan said, even in the case of an infection, an MRI before surgery can decrease procedure time by establishing a "roadmap" for the surgeon.
From "MRI Can Eliminate Unnecessary Surgery for Children With Suspected Musculoskeletal Infections"
Science Centric (11/04/2008)
Multiple Sclerosis Progression Predicted by MRI
Researchers at the Partners MS Center found that MRI scans can identify multiple sclerosis patients who are at-risk for progression of a disability, according to a study published in the Journal of Neuroimaging. Dr. Rohit Bakshi led a team of researchers in the development of a new way to detect damage to gray matter in the brain. The study showed that patients with unnatural darkness of gray matter, known as T2 hypointensity, have a higher risk of having a physical disability progress. T2 hypointensity has a closer relationship with a patient's clinical status than lesions and brain atrophy. MRI measurement of gray matter damage could be used to more accurately recognize patients who are at risk of developing MS. Further studies will be conducted to determine if excessive iron in gray matter contributes to brain damage, a discovery that could be used in the development of better treatments for MS.
From "Predicting Multiple Sclerosis Progression By MRI"
Medical News Today (11/06/08)
Surgical Removal of Small Colon Polyps Costly and Unnecessary
Polypectomy of small polyps found during CT colonography (CTC) may not be necessary, according to a study led by University of Wisconsin Prof. Perry J. Pickhardt. The researchers came to this conclusion based on an analysis of three treatment options following patients, for which a CTC discovered polyps between six and nine millimeters. Treatment options included three year colorectal cancer surveillance, immediate colonoscopy with polypectomy, or neither. Following this analysis Dr. Pickhardt observed that, "by excluding large polyps and masses, CTC screening can place patients in a very low risk category making colonoscopy for small polyps probably not warranted."
From "Surgical Removal of Small Colon Polyps Is Costly and Unnecessary, Study Suggests"
Science Daily (11/03/08)
Technology
Computer Model Improves Diagnostic Sonography
Dutch researcher Koos Huijssen has created an improved ultrasound computer model that better forecasts the behavior of ultrasonic waves in ultrasound instruments. The new model is being used by the Erasmus University Medical Centre and Oldelft Ultrasound to design a new sonographic transducer. Huijssen's model can process large volumes of data on both a PC and a parallel supercomputer. This allows calculations to be made over a three-dimensional area that is larger than what current computer models can handle.
From "Computer Model Improves Diagnostic Sonography"
News-Medical (11/05/08)
New Imaging Technology Identifies Broad Spectrum of Liver Disease
A recent study shows that a new type of imaging developed by Mayo Clinic researchers is able to accurately predict liver fibrosis, thus helping to eliminate the need for liver biopsies. The effectiveness of the technique, known as magnetic resonance elastography (MRE), was investigated in an 113-patient study presented at the annual meeting of the American Association of Liver Disease. Participants in the study, led by Mayo Clinic hepatologist Jayant Talwalkar, had already undergone biopsy in the year preceding the study and had a variety of liver diseases including hepatitis C and B, primary biliary cirrhosis, and primary sclerosing cholangitis. Results of the study found that the detection of cirrhosis by MRE when compared to liver biopsy was 88 percent accurate. Additionally, patients with nonalcoholic fatty liver disease and no significant inflammation or fibrosis were identified with 97 percent accuracy.
From "Mayo Clinic's New Imaging Technology Accurately Identifies a Broad Spectrum of Liver Disease"
Eureka! Science News (11/01/2008)
Solid Tumors Mapped in Color
A group of scientists have recorded the movement and localization patterns of tumor-infiltrating stromal cells in living mice, using confocal microscopy with multicolor imaging techniques. During a 12-hour period, they found that regulatory T cells migrated near blood vessels, their movement sensitive to the oxygen levels in tumors. The researchers also found that the movement of myeloid cells was insensitive to oxygen, with localization patterns and migration rates varying by cell-surface marker expression. This imaging technology may contribute to more effective therapies by helping to define specific stromal cells' contributions to tumor growth. The findings were published in the journal Disease Models & Mechanisms.
From "Solid Tumors in Living Color"
Science (10/24/08) Vol. 322, No. 5901, P. 506
Medical-Legal Issues
NICE Questioned as Model for Effectiveness Institute Sought by Obama
While Barack Obama has proposed a comparative effectiveness institute as part of his plan for health care reform, an analysis by health care policy research firm Lewin Group shows that not all physicians follow the many practice guidelines already in place. Such guidelines account for 20 to 33 percent of health care spending for the chronically ill, and a 2004 Lewin Group study shows adherence ranging between 17 and 71 percent. A study by Michael Cabana, published in the Journal of the American Medical Association in 1999, found 57 percent of physicians unfamiliar with existing guidelines. Some consider the U.K. National Institute for Health and Clinical Excellence (NICE) a possible model for the United States, but Andrew Dillon, NICE's current chief executive, said the system should not be adopted outside of the United Kingdom. While the U.K. clinical practice culture is more conservative with new medical techniques, advanced medical technology spreads quickly in the United States, said Health Management Associates Principal Jack Meyer, as in the case of advanced imaging techniques. Meyer also said the NICE approach concentrates too much on quality-adjusted cost as a way of measuring technology. New medical procedures instead could be paid for while evidence is gathered regarding their clinical benefit and cost-effectiveness. Michael Tanner, senior fellow at the Cato Institute, said that NICE's bureaucracy causes unnecessary delays in valuable technology.
From "Obama Wants Comparative Effectiveness Institute; Is NICE a Good Model?"
Medical Devices Today (10/23/08)
Clinical Practice
CT Scans Gain Favor as Colonoscopy Option
More medical centers across the United States are performing virtual colonoscopies, using CT colonography, instead of the traditional, more invasive method. A recent study, led by Virginia Commonwealth University Prof. Robert Halvorsen, Jr. and published in the New England Journal of Medicine found the new method to be as effective at identifying colonic polyps as traditional colonoscopies. However, the risk-benefit and cost-benefit profile of this procedure is still being developed. While a virtual colonoscopy uses the same equipment as other CT scans, it requires special software that radiologists must be trained to use. There is also some small radiation exposure that occurs with virtual colonoscopies, but it also does not have the risk of bowel perforation associated with the standard procedure.
From "CT Scans Gain Favor as Option for Colonoscopy"
Wall Street Journal (10/28/08) P. D1; Rundle, Rhonda L.
Medical Imaging Storage Capacity Demands Monitoring
A number of organizations are now in the process of installing picture archiving and communications systems (PACS). These systems are capable of storing diagnostic tests in the form of video or images. They allow healthcare professionals instant, digital access to EKG traces, Holter monitor readings, pulmonary function results, and surgical scope procedures. The new technology also helps practices handle images and videos from digital mammography systems, and echocardiograms. Such imaging storage strategies tend to be inexpensive, and storage can be bought and installed as needed. Guidelines for monitoring capacity should be developed; however, because unlike traditional imaging storage, digital imaging systems like 256-slice CT scanners consume large amounts of disk space rapidly. One way to mitigate this concern is to install a mini-PACS system as an alternative to a costlier dual-storage system. Still, no matter what type of system the practice chooses, it is always important to continuously monitor monitoring diagnostic imaging storage capacity-and add to it as needed- when operating in a digital radiology environment.
From "Medical Imaging Tests Storage Capacity"
Health Data Management (11/08) Vol. 16, No. 11, P. 32; Goedert, Joseph
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