RSNA 2008 Image Interpretation Session Archived Online
Miss the Sunday Image Interpretation Session at RSNA 2008? Access the archived session at RSNA2008.RSNA.org. Choose Image Interpretation Session from the lefthand navigation bar and then scroll down to click View Simulcast.
AMA PRA Category 1 Credit is not available for the on-demand session.
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Leading the News
FDA Issues Guidance Designed to Ensure Safe Use of Hand-Held X-Ray Equipment
The FDA's Center for Devices and Radiological Health (CDRH) has released guidance designed to promote safe use of handheld x-ray equipment. The guidance describes two primary forms of radiation exposure that could pose concern for operators of such equipment: leakage radiation transmitted through equipment housing and shielding and backscatter radiation from the patient and nearby structures. To reduce the risks associated with these types of exposure, the guidance suggests that all hand-held x-ray equipment incorporate physical means to protect the operator from leakage radiation or allow operation of the unit at a distance. All operating instructions for such equipment should also include estimated radiation exposure measurements for distances near the unit designed to help operators develop safe working practices and limit radiation exposure during equipment use. Common safe working practices identified in the guidance include the use of the lowest-possible effective radiation dose; the requirement of appropriate personnel protective equipment, such as a personnel exposure monitoring device or lead-lined gloves and gowns; the development of recommendations designed to limit the number of exposures initiated by a single operator over a period of time; and the institution of procedures to restrict use of a hand-held x-ray unit without an equipment stand or remote switch.
From "Guidance for Industry and FDA Staff: Radiation Safety Considerations for X-Ray Equipment Designed for Hand-Held Use"
FDA.gov (12/24/08)
Research
Combining PHIFU and Contrast Enhances Ultrasound's Non-Thermal Effects
The combination of pulsed high intensity focused ultrasound (PHIFU) and an ultrasound contrast agent (UCA) can enhance the non-thermal effects of ultrasound during the treatment of solid tumors, according to animal testing led by Chongqing Medical University Prof. Zhi-Biao Wang. His research, published in the World Journal of Gastroenterology, found that the pathological characteristics of non-thermal damage caused by this combination is different from those of thermal damage. Additionally, Wang determined that the use of PHIFU and UCA can promote tumor cell apoptosis and inhibit tumor cell proliferation.
From "How to Enhance Non-Thermal Effects of Ultrasound"
Science Centric (12/30/2008)
Imaging Advances Provide Immune-Cell Breakthroughs
The use of multiphoton microscopy has spread to immunologists throughout the country. Researchers from the National Institute of Allergy and Infectious Diseases (NIAID) have used the technology to discover how one gene mutation causes a human immunodeficiency disease. The findings, led by Ronald Germain, were reported at the American Society for Cell Biology annual meeting in mid-December. Jeffrey Segall of the Albert Einstein College of Medicine of Yeshiva University in New York said the college's biophotonics center used multiphoton microscopy to track cells in a mouse's body. Scientists surgically grafted a tiny glass window inside the mouse and used a laser light to follow the fluorescently labeled cells through the window. Bojana Gligorijevic, research associate at Einstein, was part of a study that used the same technique to trace cancerous cells in a breast cancer model, using a real-time view of events that cause metastasis. NIAID's Jackson Egen has also used multiphoton microscopy to watch how certain immune cells help transmit the parasite that causes leishmaniasis. With multiphoton intravital microscopy, Ulrich von Andrian of Harvard Medical School was able to find which specific cells recognize infections to the lymph nodes and present them to cells that combat the virus.
From "Imaging Advances Provide Immune-Cell Breakthroughs"
Nature (12/25/08) Vol. 456, No. 7224, P. 850; Hayden, Erika Check
MRI Emerges as Vital Resource of Back Pain Treatment
Magnetic resonance imaging (MRI) can be used to successfully evaluate patients with back pain, according to a study recently published in the Journal of the American Academy of Orthopedic Surgeons. The study, conducted by University of Wisconsin Prof. Victor M. Haughton and his colleagues, determined that MRIs can be used to identify or display the majority of spinal tissue or pathology. Additionally, the researchers found that MRIs can be used successfully to meet different clinical needs that may be associated with back pain, including the detection or display of infection, tumor, trauma and vascular disease, intervertebral disk and facet joint degeneration, and spinal canal stenosis.
From "MRI Emerges as Vital Resource of Back Pain Treatment"
eMaxHealth.com (01/01/09)
Technology
High-Sensitivity Imaging
Researchers at Harvard University have used Raman microscopy in a way that could lead to a new method of biomedical imaging. A team led by chemistry professor X. Sunney Xie has used the stimulated Raman scattering (SRS) phenomenon to map lipids in living cells and the delivery of topically applied drugs through the skin. Bulky labels are not required for SRS microscopy, as is the case with fluorescence microscopy methods. The reduced background signal helps make SRS microscopy highly sensitive and allows the method to provide images in the region of the Raman spectrum where peaks are crowded together. SRS microscopy works well in a wider range of molecules than coherent anti-Stokes Raman scattering (CARS) microscopy. "Stimulated Raman microscopy allows background-free imaging on a relatively simple platform," says Ji-Xin Cheng, a CARS specialist at Purdue University. According to Xie: "We can have all the advantages of Raman, but with much higher sensitivity, acquisition speed, and no damage to biological samples." Only one frequency is recorded at a time, so generating Raman images with complete spectra will not be easy, but the development moves us a step closer to a non-laser lab application, adds Wolfgang Zinth, head of the Center for Biomolecular Optics at Ludwig Maximilians University in Munich.
From "High-Sensitivity Imaging"
Chemical & Engineering News (12/22/08) Vol. 86, No. 51, P. 6; Arnaud, Celia
DTI Predicts Early Visual Concerns from Optical Neuritis in Patients with MS
A study led by Washington University in St. Louis Prof. Robert T. Naismith has found that a new MRI technique can predict the chronic effects of optic neuritis in multiple sclerosis patients (MS) three months in advance. The technique, known as magnetic resonance diffusion tensor imaging (DTI), uses a rapid series of MRI scans to monitor water diffusion in optic nerves. Naismith and his team used DTI to image the optic nerves of 12 healthy volunteers, 12 patients who had been diagnosed with optic neuritis in the past month, and 28 patients with a history of optic neuritis. By doing so, they were able to determine that the initial decrease in axial diffusivity brought on by optic neuritis correlates with decreased sensitivity to visual contrast one month and three months later. Their research, published in Neurology, also found that an increase in radial diffusivity detected by DTI is a good predictor of lower scores on common visual acuity exams.
From "MRI Scans Can Predict Effects of Multiple Sclerosis Flare-Ups on Optic Nerve"
Science Daily (12/31/08)
SPECT-CT Provides More Accurate Images of Possible Lymph Node Metastasis
A hybrid imaging technique, known as single photon emission computed tomography-computed tomography (SPECT-CT), is able to more accurately distinguish between cancerous cells in regional lymph nodes and normal residual tissue following the removal of a patient's thyroid gland. SPECT-CT was tested by University of Erlangen-Nurnberg Prof. Daniela Schmidt and her colleagues on 57 patients who received radioiodine therapy after they had undergone thyroid removal. Their research, found in the Journal of Nuclear Medicine, showed that SPECT-CT imaging was able to detect tumor metastasis earlier than other imaging techniques. Additionally, the use of SPECT-CT led to the revision of a previous diagnosis in 35 percent of patients.
From "Molecular Imaging Enables Earlier, Individualized Treatment of Thyroid Cancer"
Nanotechwire.com (01/04/09)
Medical-Legal Issues
FDA Approves First Imaging Agent to Enhance Scans of Blood Flow
The FDA has granted marketing approval for gadofosveset trisodium (Vasovist Injection). This product is the first contrast imaging agent approved specifically for the improvement of image quality in patients undergoing magnetic resonance angiography (MRA). The approval was granted based on two clinical studies of patients with known or suspected aortoiliac disease. Study participants underwent MRA with and without Vasovist. Scans were then compared to standard x-ray images using contrast. MRA with Vasovist detected more arterial disease and produced images considered better quality. However, because Vasovist contains gadolinium, its approval comes with the stipulation that its packaging must carry a Boxed Warning that it may be associated with allergic reactions and nephrogenic systemic fibrosis, as mandated by an FDA ruling from May 2007.
From "FDA Approves First Imaging Agent to Enhance Scans of Blood Flow"
FDA.gov (12/24/08)
Clinical Practice
Family History of Prostate Cancer Does Not Affect Some Treatment Outcomes
First-degree family history of prostate cancer does not affect the treatment outcomes of patients undergoing brachytherapy nor does it have an impact on their clinical or pathological characteristics, according to a study led by Mount Sinai School of Medicine Prof. Christopher A. Peters. By following 1,738 prostate cancer patients, including 187 with a first-degree family history of prostate cancer, for an average of 60 months, Peters and his colleagues were able to determine that there was little to no difference in prognostic outcomes for patients designated as low, intermediate, and high-risk based on their family history. The full study can be found in the International Journal of Radiation Oncology, Biology, and Physics.
From "Family History of Prostate Cancer Does Not Affect Some Treatment Outcomes"
Science Daily (01/02/09)
Study Reveals Need for New Tactics to Encourage Prostate Cancer Screening in Single Men
Men with a heightened risk of prostate cancer who live alone, without a wife or a partner, are less likely to seek screening for prostate cancer than those with no family history of the disease, according to a new study led by University of Michigan Prof. Lauren P. Wallner. The study, published in Cancer Epidemiology, Biomarkers, and Prevention, analyzed the medical records of 2,447 men to determine how often they had requested screening for prostate cancer. Overall, Wallner and her colleagues found that men with a family history of prostate cancer were 40 percent more likely than men with no family history to seek screening. However, the researchers also discovered that family history was only a motivator of married or cohabitating men. The researchers say prevention efforts including information on prostate-cancer screening and treatment should target wives and significant others as well as men.
From "Men Who Live Alone Fall Short on Prostate Cancer Screening"
Reuters (12/25/08)
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