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From RSNA
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
From RSNA
February RSNA News Now Online
The full version of the February issue of RSNA News is now available online.
Highlights include:
Visiting Professors Find Modern Radiology Departments in China
Teams of professors visiting China through RSNA's International Visiting Professor Program exchanged knowledge with radiologists in some of the country's most state-of-the-art hospitals.
Simulation Technology Challenges Traditional Radiology Education
Although still in its infancy, simulation technology holds great promise as a powerful interactive learning tool in radiology.
Radiologists Seek Ways to Measure and Improve Productivity
More than half of radiologists in private practice, along with the majority of those in academia, now feel the need to measure their productivity, according to presenters of an RSNA 2008 refresher course.
TACE Targets Liver Cancer with Fewer Side Effects
Patients with inoperable liver cancer treated with targeted chemotherapy administered by an interventional radiologist live longer and experience a better quality of life, according to a new study presented at RSNA 2008.
Engineering Approach Could Change Brain Tumor Outcomes
A new study shows that diffusion tensor imaging could more accurately pinpoint the edges of brain tumor infiltration, thus allowing for more precise radiation treatment.
2008 RSNA Annual Report Now Available
Look for the 2008 RSNA Annual Report to arrive with the February issue of RSNA News. The Annual Report is available now as a PDF on RSNA.org.
Leading the News
CMS' Rejection of Screening Colonography Payment Vexes Radiologists
The Centers for Medicare and Medicaid Services (CMS) announced on Feb. 11 that it will deny reimbursement for CT colonography (CTC) because it has concluded that there is not adequate scientific evidence to definitely conclude that CTC provides improves net health benefits for Medicare beneficiaries as a method of screening for colorectal cancer. CMS is now accepting comments on this ruling and will issue a final decision regarding CTC reimbursement at the conclusion of the 30-day comment period. Already, radiologists have voiced their concern over the draft ruling. University of Wisconsin associate professor of radiology Dr. Perry J. Pickhardt argues that there is adequate evidence to support CTC reimbursement. Dr. Pickhardt was the lead author of a 2003 study, published in the New England Journal of Medicine, that showed that CTC was just as sensitive as optical colonoscopy for detecting suspicious colon polyps greater than 6 mm. Furthermore, Pickhardt says, only a minority of Medicare beneficiaries are regularly screened for colorectal cancer using already-covered methods.
From "CMS' Rejection of Screening Colonography Payment Vexes Radiologists"
Diagnostic Imaging (02/09)
Research
Chemotherapy, Radiation, and More Chemotherapy Most Effective Sequence for Advanced Endometrial Cancer
Chemotherapy followed by radiation followed by more chemotherapy (CRC) appears to be the most effective pattern for extending survival time for patients with advanced-stage endometrial cancer, according to a study conducted by Duke University Prof. Angeles Alvarez and colleagues. For the purposes of their research, reported at the annual meeting of the Society of Gynecologic Oncologists, Alvarez's team retrospectively evaluated the efficacy of CRC compared to two other treatment modalities: radiation followed by chemotherapy and chemotherapy followed by radiation, between 1993 and 2007. They found that patients treated with CRC had better rates of three-year overall survival and progression-free survival compared to either of the other treatment modalities.
From "Chemotherapy, Radiation, and More Chemotherapy Most Effective Sequence for Advanced Endometrial Cancer"
Doctor's Guide (02/06/09)
MRI Shows Brain Atrophy Pattern That Predicts Alzheimer's
University of California San Diego researchers, led by Dr. Linda K. McEvoy of the Department of Radiology, report that by using specific quantitative MRI methods, they were able to identify a pattern of regional brain atrophy in patients with mild cognitive impairment (MCI) that may indicate they have a greater risk of progressing to Alzheimer's disease. In the study, published in Radiology, the researchers analyzed brain MR images from 84 patients with mild Alzheimer's disease as well as 175 patients with MCI and 139 healthy controls. They found that some patients with MCI showed widespread cortical atrophy. However, researchers also found that MCI patients with atrophy in parts of the medial and lateral temporal lobes and in the frontal lobes (a pattern also seen in patients with mild Alzheimer's) were most likely to experience future cognitive decline.
From "MRI Shows Brain Atrophy Pattern That Predicts Alzheimer's"
Science Daily (02/10/09)
Stroke Therapy Window Might Be Extended Past Nine Hours for Some
A recent study conducted by Dr. William A. Copen, Advanced Magnetic Resonance Neuroimaging, at Massachusetts General Hospital, and colleagues, found that some patients suffering from ischemic stroke may benefit from receiving thromboembolytic therapy between nine and 24 hours following the onset of the stroke. Copen and his team performed perfusion and diffusion MRI on 109 patients in an effort to detect a mismatch between the two images that would indicate areas of the brain that may be threatened by lack of blood flow but could still be restored. Their research is published in the journal Radiology.
From "Stroke Therapy Window Might Be Extended Past Nine Hours for Some"
Doctor's Guide (02/09/09)
Technology
Sonography May Be Appropriate Primary Imaging Modality for Localization of Parathyroid Adenomas
Radiologist-performed sonography may be the best principal imaging modality for patients with primary hyperparathyroidism (HPTH), according to a recent study conducted by University of Pittsburgh Radiologist Dr. Mitchell E. Tublin and colleagues. Tublin and his team performed sonography and technetium Tc 99m sestamibi single-photon emission computed tomography (SPECT) on 172 patients to determine the need for parathyroidectomy. They found that the sensitivity, specificity, and positive predictive value of sonography for identifying abnormal parathyroid glands were 74 percent, 96 percent, and 90 percent, respectively. Sensitivity, specificity and positive predictive value of SPECT, on the other hand, were 58 percent 96 percent, and 89 percent. However, five patients with negative sonographic findings were shown to have uniglandular disease when examined using SPECT. Tublin recommends selective use of SPECT when sonographic findings are negative or equivocal.
From "Localization of Parathyroid Adenomas by Sonography and Technetium Tc 99m Sestamibi Single-Photon Emission Computed Tomography Before Minimally…"
Journal of Ultrasound in Medicine (02/01/09) Vol. 28, No. 2, P. 183; Tublin, Mitchell E.; Pryma, Daniel A.; Yim, John H.
Sequential and Alternating Chemotherapy and Radiation Therapy Similarly Effective for Larynx Cancer
Sequential and alternating chemotherapy and radiation therapy are similarly effective in patients with operable, advanced, squamous cell cancer of the larynx or hypopharynx, according to researchers affiliated with the EORTC Radiation Oncology Group. In a Phase III clinical trial involving 450 patients, the researchers assigned half the patients to alternating therapy, and half to sequential therapy. Patients in both groups who did not respond to treatment underwent laryngectomy. In six years of follow-up, the rates of larynx preservation, overall survival, and progression-free survival were not significantly different between the two groups. Functional larynx was achieved in 30.5 percent of patients in the sequential group and 36.2 percent in the alternating group. For the sequential group, median progression-free survival was 3.0 years, and 3.1 years in the alternating group. In the alternating group, 22.1 percent of patients required surgery, compared to 30.1 percent in the sequential group. The researchers noted that acute side effects such as mucositis may have been less common among patients in the alternating group, and that data trends for functioning larynx and toxicity favor the alternating therapy. The study was published online in the Journal of the National Cancer Institute.
From "Sequential and Alternating Chemotherapy and Radiation Therapy Similarly Effective for Larynx Cancer"
CancerConsultants.com (01/27/2009)
Medical-Legal Issues
Experts Release Guidelines on Use of Breast MRI
New guidelines published in the Journal of the National Comprehensive Cancer Network reaffirm screening, mammography, and ultrasound as the primary diagnostic modalities for breast cancer. Also published in the journal was research conducted by the Seattle Cancer Care Alliance and the Roswell Park Cancer Institute, indicating that MRI should be used selectively in situations such as providing a more detailed image of suspicious lesions and detecting cancer in the contralateral breast. The guidelines recommend imaging centers be able to perform MRI-guided needle biopsy of any MRI-detected lesions prior to any decision regarding surgical options.
From "Experts Release Guidelines on Use of Breast MRI"
EmpowHer (02/16/2009)
Risk of Malpractice Lawsuits in Breast Imaging Overestimated by Radiologists
Radiologists may overestimate their exposure to malpractice claims, according to a recent study led by University of Washington Prof. Joann G. Elmore. This conclusion was based on two surveys of radiologists conducted by Elmore and her colleagues in 2002 and 2006. Results of the surveys showed that in 2002, a radiologist's perceived risk of being sued in the next five years was 41 percent in 2002 and 35 percent in 2002. By contrast, the actual number of radiologists who reported malpractice claims was 8 percent five years prior to 2002 and 10 percent five years prior to 2006.
From "Risk of Malpractice Lawsuits in Breast Imaging Overestimated by Radiologists"
News-Medical.Net (02/03/2009)
NHS Funding Restricts Access to Interventional Radiology Procedures
Patient access to interventional radiology (IR) procedures may be jeopardized by the U.K.'s National Health Service (NHS) funding system, according to Royal College of Radiologist Prof. Andy Adam. Currently, IR procedures are funded through the NHS smaller radiology budgets, rather than from more generous surgical budgets--a system that Adam claims significantly limits access to IR procedures in many parts of the United Kingdom. Due to this problem, Adam has asked that NHS conduct a review of its funding system for such procedures.
From "X-Ray Surgery 'Lacking' in UK"
BBC News (02/03/09)
Clinical Practice
Cervix Motion Confounds Radiotherapy Planning
Cervical movement between radiotherapy fractions can cause treatment errors, according to a recent study conducted by University of California San Diego Prof. Cheryl Saenz and colleagues. The study, reported at the Society of Gynecologic Oncologists annual meeting, included a retrospective review of 10 patients with cervical cancers treated with intensity-modulated radiotherapy (IMRT) between 2007 and 2008. Patients received 25 fractions of IMRT chemoradiation. Before and after each radiation treatment, radiologists obtained both anterior-posterior and x-rays. By doing so, researchers found that average intrafractional cervical movement was 4.42 mm laterally, 4.29 mm vertically, and 5.02 mm in the anterior-posterior direction while average interfractional movement was 4.89 mm laterally, 5.03 mm vertically, and 4.89 mm in the anterior-posterior direction. Maximum movement for each direction ranged from 0 mm to 32 mm.
From "Cervix Motion Confounds Radiotherapy Planning"
MedPage Today (02/11/09) Bankhead, Charles
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