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Headlines
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
Leading the News
Radiologists Encourage Improved Communication to Limit Unnecessary Surgery
Advanced medical imaging modalities such as MRI and CT scanning are far more sensitive than their predecessors. As such, they are able to detect far more musculoskeletal abnormalities. However, recent research indicates that radiologists must be cautious when using these new technologies as diagnostic tools because they may detect abnormalities that are not the cause of the patient's pain, possibly leading to unnecessary surgical intervention. One such study was led by Boston University Prof. David Felson and published in the New England Journal of Medicine. Dr. Felson and his colleagues performed MRI scans on 991 patients, some of whom had knee pain and some who did not. They found that meniscal tears were just as common in people with knee arthritis who did not complain of pain as they were with people who did have pain, indicating that repairing the detected tears would not necessarily eliminate the pain. To reduce the instance of unnecessary surgery, some radiologists have taken steps to improve communication with surgeons and primary care physicians by including epidemiological data with the scan.
From "The Evidence Gap: The Pain May Be Real, But the Scan Is Deceiving"
New York Times (12/09/08)
Research
Ultrasound-Guided Steroidal Injections Relieve Heel Pain in Patients With Plantar Fasciitis
Ultrasound-guided steroidal injections are able to relieve symptoms of plantar fasciitis in 95 percent of patients, according to a study led by Dr. Luca M. Sconfienza of the University of Genoa. The technique, reported at RSNA's annual meeting, was used by Dr. Sconfienza and colleagues on 44 patients with plantar fasciitis that was unresponsive to conservative treatment. Patients were injected with a steroid around the fascia to eliminate inflammation and pain. Ultrasound guidance was used to improve accuracy and avoid injection the steroids directly into the plantar fascia, which can cause it to rupture. Of the 44 patients, 42 experienced complete relief of their symptoms within three weeks.
From "New Treatment Eliminates Heel Pain Caused by Plantar Fasciitis"
Science Daily (12/11/08)
Scientists Developing Brain Imaging Methods for Studying Natural Human Behavior
UC San Diego researchers, led by Scott Makeig, are currently developing a new imaging modality. The modality, known as Mobile Brain/Body Imaging (MoBI), is designed to allow scientists to study subject brain function while performing normal human activities in a 3-D environment. To achieve this goal, MoBI will utilize a combination of non-invasive electroencephalographic technology with full-body motion capture to explore the distributed brain dynamics that accompany natural human behaviors.
From "UC San Diego Scientists Developing Brain Imaging Methods for Studying Natural Human Behavior"
Genetic Engineering News (12/10/08)
Ultrasound Screening Helps Prevent Stroke in Children With Sickle Cell Disease
Physicians a the Children's Hospital of Philadelphia, led by Dr. Janet L. Kwiatkowski, have found that transcranial Doppler ultrasonography (TCD) significantly reduces the incidence of stroke in children with sickle cell disease when combined with regular transfusions for children found to be at high risk of stroke. Dr. Kwiatkowski and her team followed 475 children treated at the hospital before the introduction of TCD and 530 children after its introduction. They found 21 strokes in the pre-TCD group compared to just two strokes in the group using TCD. The full results of the study were reported at the annual meeting of the American Society of Hematology.
From "Ultrasound Screening Helps Prevent Stroke in Children With Sickle Cell Disease"
Science Centric (12/07/2008)
Technology
PACS Systems Expand With Government Support
Picture archiving and communications systems (PACS) were once used only in a hospital's radiology department but they are now becoming components of departmental, local, and national radiology networks. The government PACS leader is the Veterans Affairs Department (VA), which is planning to launch a nationwide teleradiology network in January to support local PACS operations and install gateways at VA hospitals. The new system would allow communication between the Veterans Health Information Systems and the Technology Architecture electronic health record system and PACS to choose the cases that must be sent to the teleradiology server. With the teleradiology application, VA hospitals will send images to a server in Sacramento, Calif., through which all VA radiologists can access the images. The use of multifacility PACS has also gained interest at other hospitals. However, interoperability can be a problem in sharing images between facilities. In order to help solve this problem, some experts support the development of a national index of images, which would maintain data on the location of images stored in several PACs. Based on a similar idea, the Defense Department (DOD) is developing the Healthcare Artifact and Image Management Solution for images and documents currently stored throughout DOD. This index would also capture metadata to identify each image and correlate it to the patient.
From "Imaging Meets the Network"
Government Health IT (11/20/08) Moore, John
New Imaging Technique Tracks Cancer-Killing Cells Over Prolonged Period
PET-CT scans can be used to track the function of cell-based disease therapies with the help of a gene-based imaging reporter, according to a study conducted by Stanford University radiologist Sanjiv Gambhir and his team. For the purposes of the study, published in Nature Clinical Practice Oncology, the researchers modified therapeutic cells to express a unique reporter gene. Then, an imaging agent contained only in cells expressing the reporter gene, was injected into the patient. By studying the function of the therapeutic cells containing a reporter gene in a patient with glioblastoma, Gambhir and his team came to several conclusions. First, they discovered that unlike external radioactive tags usually used in PET scanning, the reporter gene is expressed throughout a cell's lifetime but not beyond. Additionally, the reporter gene is duplicated and passed along every time the therapeutic cell multiplies. And finally, the genes not only show where the cells are but what they are doing.
From "New Imaging Technique Tracks Cancer-Killing Cells Over Prolonged Period"
Science Daily (12/07/08)
Medical-Legal Issues
Cardiovascular and Renal Drugs Advisory Committee Recommends Against Approval for Imagify
The FDA Cardiovascular and Renal Drugs Advisory Committee has recommended against approval for Perflubutane Polymer Microspheres (Imagify) for use as a contrast agent for echocardiograms. The recommendation was based on the committee's conclusion that the benefits of Imagify were outweighed by possible adverse event risks, including patients who experienced low blood pressure and syncope. The FDA is scheduled to make a final decision whether or not to approve Imagify by late February 2009.
From "FDA Panel Pans Acusphere Heart-Imaging Drug"
Associated Press (12/11/08)
Medical Device Safety Institute Hopes to Improve Postmarketing Surveillance for Devices
Harvard cardiologist William Maisel and his colleagues are working to build up the Medical Device Safety Institute to help fill gaps in data collection and public communication on safety issues for medical devices. Since its founding, the institute has conducted and published three studies. The first study tracked off-label use of biliary stents to treat peripheral vascular disease from 2003 to 2006. The researchers concluded that off-label use was increasing, and most biliary stent adverse effects resulted from off-label use. This study was published in January in the American Journal of Therapeutics, after which the Department of Justice began to investigate the issue. Another study showed that the researchers could wirelessly reprogram an implantable cardioverter defibrillator (ICD) to disable the defibrillator or deliver an unnecessary shock, and also could retrieve personal patient information from the device. Maisel and colleagues reported at the American Heart Association meeting in New Orleans last month that magnets commonly used in headphones can interfere with pacemaker and ICD functioning if placed within an inch of the device.
From "Harvard’s Maisel Builds An Institute To Spotlight, Explain Device Risks"
Medical Devices Today (12/02/08) Filmore, David
Clinical Practice
Focus Turns to Preventing MRSA Infections in MRI Suites
The Centers for Disease Control and Prevention reports that each year, 1.7 million people in the United States contract hospital-acquired infections. To prevent these infections, a number of states and healthcare organizations have instituted strict policies designed to improve prevention, treatment, and tracking of these infections. However, one of the areas where aggressive bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) can be easily contracted, that has been overlooked until recently, is in MRI facilities. Experts say that in order to prevent these types of infections, radiologists should ensure they do not simply change sheets that cover MRI table pads but should make sure the pads themselves are cleaned. Pads should also be promptly replaced if they become damaged or frayed because such tears make MRSA and other bacteria difficult to remove. Additionally, Irish researchers recently confirmed the presence of MRSA in an MRI suite by culturing the MRI bore. Experts say the bore is a particular area of concern because they are sometimes not cleaned on a regular basis but come in close contact with patients.
From "Patients Develop Superbug MRSA Infections After Undergoing MRI Scanning"
eMaxHealth.com (12/05/08)
Women at High Risk of Breast Cancer May Benefit From Alternating Mammography and MRI
University of Texas Prof. Huong Le-Petross and his team recently found that alternating MRI and mammogram screenings every six months can increase the number of breast cancers not detected by mammography alone. For their research, reported at the 31st San Antonio Breast Cancer Symposium, they conducted a retrospective chart review of 334 women who had participated in a high-risk breast cancer-screening program. They found that alternating MRI and mammography detected nine cancers. Fifty five percent of these cancers were identified by MRI but not by mammography, 33 percent were found by both MRI and mammography, and 11 percent was not detected by either screening technique. No cancer was detected by mammography alone.
From "Women at High Risk of Breast Cancer May Benefit From Alternating Mammography and MRI"
Medical News Today (12/15/08)
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