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Research
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From RSNA
March RSNA News Now Online
The full version of the March issue of RSNA News is now available online.
Highlights include:
Treadmill Workstations Get Radiologists Moving
Radiologists can add simultaneous physical exercise on a treadmill to their daily image reading routines without compromising diagnostic accuracy, according to an exhibit presented at RSNA 2008.
Filters Lower Radiation Dose in Adult, Pediatric CT
New research shows that radiation dose can be reduced in adult and pediatric CT scans with 2D non-linear adaptive filters that decrease image noise in low-dose CT scans without compromising image quality.
Cardiac CT Studies Demonstrate Low Radiation Risk
New studies presented at RSNA 2008 challenge reports of high radiation risk from cardiac CT and offer ways to even further reduce the risk.
Photos Increase Radiologist-Patient Connection
Seeing a patient's face in a photograph alongside a CT exam prompts radiologists to give a more meticulous reading, according to a study presented at RSNA 2008.
RadiologyInfo Uses Sound to Amplify Success
Coordinators of the award-winning patient information portal RadiologyInfo.org are looking to the future by adding audiovisual presentations and other tools to enhance the experience of site visitors.
Leading the News
Obama Picks FDA Chief
President Obama has officially named Dr. Margaret A. Hamburg as his nominee to be the next FDA commissioner. In his weekly address, Obama also said Dr. Joshua Sharfstein will act as Hamburg's deputy. Hamburg is a former New York City health commissioner who served as the assistant director of the National Institute of Allergy and Infectious Diseases and as assistant health secretary during the Clinton administration. Sharfstein is currently the health commissioner for the city of Baltimore.
From "Obama Picks FDA Chief"
Voice of America News (03/14/09)
Research
MRI Links Alzheimer's Marker to Early Brain Damage
Researchers, led by Washington University Prof. Anne Fagan, used MRI to connect amyloid beta 42 (A-beta 42) to individuals who have brain damage but no signs of mental impairment. For the purposes of their study, published in the Annals of Neurology, Fagan and colleagues analyzed the levels of A-beta 42 in the cerebrospinal fluid (CSF) and conducted MRI scans of the brains of 29 patients with very mild cognitive impairment and 69 who were cognitively normal. They found that participants with normal levels of A-beta 42 in their CSF had brain volumes that fell within expected parameters. However, they also discovered that those patients with lower levels of A-beta 42 in their CSF also had lower brain volumes as measured by MRI, regardless of whether they were considered cognitively impaired.
From "MRI Links Alzheimer's Marker to Early Brain Damage"
Advance (03/16/09)
Brain Tumor Combination Treatment Improves Survival
A recent study, conducted by University of Lausanne Professor Roger Stupp and colleagues, found that combined postoperative treatment of glioblastoma using radiation and temozolomide improves five-year survival over radiation use alone. The researchers randomly assigned 573 patients with newly diagnosed glioblastoma to radiotherapy or radiotherapy plus temozolomide followed by adjuvant temozolomide. The resulting study, published in The Lancet Oncology, found that 97 percent of patients treated with radiotherapy alone died within the five-year period, compared with 89 percent of patients treated with radiotherapy plus temozolomide.
From "Brain Tumor Combination Treatment Improves Survival"
Modern Medicine (03/09/09)
IR Procedures May Reduce C-Section Complications
Interventional radiology procedures such as embolization may be appropriate treatment modalities for women with complications associated with cesarean sections, according to two studies recently presented at the Society of Interventional Radiology's 34th Annual Scientific Meeting. The first study, presented by Dr. Michael S. Stecker of Brigham and Women's Hospital, analyzed the medical records of 13 women who underwent embolization to control bleeding following a cesarean section. According to Stecker, embolization was able to stop bleeding "promptly and effectively with minimal complications." The second study, led by Dr. J. Robert D. Beecroft and Dr. John R. Kachura of Mount Sinai Hospital, included the records of 14 women who were diagnosed with invasive placenta by a predelivery MRI. These women were then treated using preoperative prophylactic insertion of bilateral internal iliac artery occlusion balloons to block excessive blood flow during delivery. Using this method, the researchers were able to decrease bleeding, allowing 75 percent of women to avoid hysterectomy following delivery, compared to previous statistics which showed that 80 percent of women with invasive placenta required hysterectomy following delivery.
From "Oh Baby, Interventional Radiology Makes Childbirth Safer"
Eureka! Science News (03/10/2009)
Technology
MR Enterography Provides Accurate, Radiation-Free Method for the Evaluation of Patients With Crohn Disease
MR enterography is the most accurate, radiation-free, technique for the detection of active small-bowel inflammation and extraenteric complications in patients with Crohn disease (CD), according to a recent study by Dr. Seung Soo Lee of Seoul's University of Ulsan College of Medicine and colleagues. The clinical trial included 30 patients who underwent CT and MR enterography and small-bowel follow-through (SBFT) examination. They found that sensitivity values for detection of extraenteric complications were 100 percent for both CT and MR enterography, compared to 32 percent and 37 percent for two SBFT readers. However, because MR enterography does not require exposure to radiation, Lee and colleagues concluded that it has the best potential for evaluation of patients with CD.
From "Crohn Disease of the Small Bowel: Comparison of CT Enterography, MR Enterography, and Small-Bowel Follow-Through as Diagnostic Techniques"
Radiology (11/10/09) Lee, Seung Soo; Kim, Ah Young; Yang, Suk-Kyun
'Seeing' Stem Cells Help in Fight Against Peripheral Arterial Disease
Interventional radiologists may be able to use stem cells to create blood vessels to treat peripheral arterial disease (PAD), according to a study presented by Johns Hopkins Prof. Frank Wacker at the Society of Interventional Radiology's 34th Annual Scientific Meeting. Wacker and his team used C-arm CT to precisely target delivery of the stem cells in relationship to blood vessels. By doing so, researchers were able to image the procedure without transferring to a separate CT scanner.
From "'Seeing' Stem Cells Help in Fight Against Peripheral Arterial Disease"
Society for Interventional Radiology (09/10/2009)
PET Scans May Detect Effectiveness of Chemotherapy Faster Than Previously Expected
Several recent studies have found that PET scans, both standard and with radioactive fluorothymidine (FLT), may provide information regarding the effectiveness of chemotherapy treatments much faster than previously expected. Dr. Steven Larson, of the Memorial Sloan-Kettering Cancer Center in New York, said that the standard PET scan provides good results for breast, prostate, colorectal, and esophageal cancers, showing the effects of chemotherapy within 10 to 14 days. One such study, led by Korean researchers, included 28 patients with advanced lung cancer. In that trial, researchers found that by using FLT PET scanning they were able to determine which patients would respond to the treatment after one week with 93 percent certainty. Another clinical trial, conducted by University of Wisconsin researchers, studied seven patients with acute myeloid leukemia. That study found that FLT PET allowed physicians to image results of aggressive chemotherapy treatment as soon as one day after the therapy began.
From "Is My Chemo Working? Scans May Give Faster Answer"
Associated Press (03/04/09) Ritter, Malcolm
Medical-Legal Issues
The Joint Commission Expresses Concern Over Poor Infection Control in MRIs
The Joint Commission's "Preventing Infections in the MRI Suite: Magnetic Environment Poses Strong Challenges" paper issues recommendations to reduce the risk of infection within MRI suites, and the group plans to scrutinize these facilities during future accreditation inspections. Probable areas of scrutiny detailed in the report include the existence of an infection control policy, how and when the MRI is cleaned, who performs the cleaning and what training they have received, and examining all table pads. Inspection may even include the use of a black light to reveal biological material embedded in MRI pads, tables, or within the MRI bore itself. The Joint Commission will evaluate whether the MRI suite is following Center for Disease Control and Prevention (CDC) guidelines. For example, CDC guidelines state that a clean sheet is not sufficient to act as a barrier for infectious agents, and pads on the table and coils must be cleaned between patients, not merely covered.
From "The Joint Commission Expresses Concern Over Poor Infection Control in MRIs"
MSNBC (03/04/09)
Clinical Practice
Independent Review of Diagnostic Scans and other Strategies Reduce Medical Errors
Diagnostic errors cause an estimated 40,000 to 80,000 hospital deaths in the United States each year, but there are steps that may be able to mitigate the risk of such errors, write Johns Hopkins University Profs. David Newman-Toker and Peter Pronovost. According to the Harvard Medical Practice Study, 14 percent of physician errors are diagnostic, compared to 9 percent that are drug-related. However, practical solutions to correct diagnostic errors have not been widely tested in clinical settings. To correct this oversight, the authors recommend that investigators design and pilot programs that identify harm due to diagnostic errors in specific clinical scenarios. They also suggest that any workable approach to reducing diagnostic errors focus on a number of different solutions, including renewed efforts to improve diagnostic education as well as diagnosis-support software and encouraging independent secondary reviews of x-ray, CT scans, and other common diagnostic tests.
From "Diagnostic Errors: The Next Frontier for Patient Safety"
Journal of the American Medical Association (03/11/09) Vol. 301, No. 10, P. 1060; Newman-Toker, David E.; Pronovost, Peter J.
Correct Modality Choice Proves Essential in Head and Neck Trauma
CT and MRI can both be helpful in diagnosing head and neck trauma, but radiologists must ensure they use the proper modality for the specific clinical circumstances. According to Dr. Ulrich Linsenmaier of the department of clinical radiology at Ludwig-Maximilians University in Munich, CT should be used to detect injuries requiring immediate neurosurgical intervention. However, he cautions that it cannot detect small nonhemorrhagic lesions and is insensitive for diffuse axonal injury (DAI), increased intracranial pressure, edema, and ischemia. Linsenmaier also recommends follow-up CT in cases of confirmed patient deterioration and to detect delayed hematoma, hypoxic lesions, and cerebral edema. In the case of MRI, Linsenmaier encourages its use for detecting subacute or chronic lesions, atrophy, focal encephalomalacia, hydrocephalus, and chronic subdural hematoma, but it is not currently indicated for nonhemorrhagic lesions, DAI, and dissections.
From "Correct Modality Choice Proves Essential in Head and Neck Trauma"
Diagnostic Imaging (03/09/09) Ward, Phillip
RSNA Weekly is a briefing of the latest radiology-related news selected from hundreds of sources by the editors of Information, Inc. While care is taken to use good sources, inaccuracies in source material are not the responsibility of RSNA or Information, Inc.
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