Apply Now for RSNA Clinical Trials Methodology Workshop
Applications are being accepted for the next RSNA Clinical Trials Methodology Workshop, to be held January 9–15, 2010, at the Hyatt Regency Scottsdale, Arizona.
Over the course of this 6½-day workshop, each trainee will develop a protocol for a clinical study, ready to include in an application for external funding. Topics to be covered include principles of clinical study design and statistical methods for imaging studies. Applicants will undergo a competitive selection process for entrance into the course.
The application deadline is June 8. The application and more information are available online. For more information, contact Fiona Miller at 1-630-590-7741 or fmiller@rsna.org.
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Leading the News
Sebelius Confirmation Faces Delay
The confirmation of President Obama's nominee for the new Secretary of the Department of Health and Human Services (HHS) has been delayed, likely until at least mid-to late April. The delay of the confirmation of Kansas Gov. Kathleen Sebelius was caused by Senate Republicans' request that they have more time to review the nomination. The vote on confirmation will now have to wait until after Congress' two-week recess, which began on April 6.
From "Sebelius Confirmation Faces Delay"
Modern Healthcare (04/02/09) DoBias, Matthew
Research
MR Imaging Detects Increased Myocardial LGE in Ostensibly Healthy Marathon Runners
By using delayed-enhancement cardiac magnetic resonance (MR) imaging, Dr. Frank Breuckmann of the West German Heart Center Essen and colleagues determined that healthy marathon runners have an unexpectedly high rate of myocardial late gadolinium enhancement (LGE). Breuckmann and his team performed delayed-enhancement cardiac MR imaging on 102 ostensibly healthy male runners who had completed a minimum of five marathons during the past three years. The results of these scans were compared to 102 age-matched control subjects. Of the 102 runners, 12 percent had LGE, compared to 4 percent of the controls. In addition, the researchers found that the event-free survival rate was lower in runners with myocardial LGE than those without myocardial LGE. Full results of the study can be found in Radiology.
From "Myocardial Late Gadolinium Enhancement: Prevalence, Patter, and Prognostic Relevance in Marathon Runners"
Radiology (04/01/09) Vol. 251, No. 1, P. 50; Breuckmann, Frank; Mohlenkamp, Stefan; Nassenstein, Kai
Researchers Use 3.0-T DT MR Imaging to Detect White Matter Differences in Children With Developmental Dyslexia
Researchers, led by Dr. Nancy Rollins of the Children's Medical Center Department of Radiology in Dallas, used 3.0-T diffusion-tensor (DT) magnetic resonance (MR) imaging to detect differences in the white matter of children who read normally and those with developmental dyslexia. Rollins and colleagues performed DT imaging on 19 children with developmental dyslexia and 18 normal-reading, age-matched pediatric control subjects. Regions of interest in the study were focused on the superior longitudinal fasciculus, the inferior fronto-occipital and inferior longitudinal fasciculi (IFO-ILF), and the posterior limb of the internal capsule (PLIC). Results of these studies, which can be found in Radiology, included a nonsignificant increase in mean axial diffusivity in the IFO-ILF in the control group but not in the dyslexia group, increases in axial diffusivity in the PLIC in the control group but not the dyslexia group, and a lack of any marked differences in tensor metrics between the left and right hemispheres within or between the two groups.
From "Simple Developmental Dyslexia in Children: Alterations in Diffusion Tensor Metrics of White Matter Tracts at 3 T"
Radiology (04/03/09) Rollins, Nancy K.; Behroze, Vachha; Srinivasan, Priya
PCT Plays Prognostic Role in Patients With SCCA Following Surgical Excision
Dr. Sotirios Bisdas and colleagues from the Medical University of South Carolina recently conducted a study which found that pretreatment perfusion computed tomography (PCT) may have a prognostic role in patients with oral cavity, oropharynx, and hypopharynx squamous cell carcinoma (SCCA) following surgical excision. The researchers performed PCT on 21 patients with SCCA at the level of the largest tumor diameter based on standard neck CT. In order to take PCT measurements, particular regions were free-hand positioned on the lesions. Tumor volume was also calculated. Follow-up was conducted with PET/CT and endoscopy.
From "Outcome Prediction After Surgery and Chemoradiation of Squamous Cell Carcinoma in the Oral Cavity"
International Journal of Radiation Oncology, Biology, Physics (04/09) Vol. 73, No. 5, P. 1313; Bisdas, Sotirios; Nguyen, Shaun A.; Anand, Sharma K.
MRI and MR Arthrography Provides Effective Evaluation Tool for the Ligaments of the Posterior and Lateral Talar Processes
MRI and combined ankle and posterior subtalar MR arthrography in cadavers were used to evaluate the ligaments of the posterior and lateral talar processes by researchers from the University of Sao Paulo in Brazil and the University of California, San Diego. In all subjects, MR arthrography provided improved delineation of the articular and periarticular structures as well as the ligaments. The lateral talocalcaneal and medial talocalcaneal ligaments were best seen in the axial and coronal planes, respectively. The axial plane was best for visualizing the fibulotalocalcaneal ligament, while the sagittal plane was best for evaluating the posterior talocalcaneal ligament. The axial plane was best for seeing the anterior and posterior talofibular ligaments and the posterior tibiotalar ligament. The researchers concluded that combined ankle and posterior subtalar MR arthrography improves visualization of the ligaments attaching to the posterior and lateral talar processes, including the posterior, lateral, and medial talocalcaneal and fibulotalocalcaneal ligaments.
From "MRI and MR Arthrography of the Ankle and Posterior Subtalar Joint"
American Journal of Roentgenology (04/01/2009) Vol. 192, No. 4, P. 967; Pastore, Daniel; Cerri, Giovanni G.; Haghighi, Parviz
Technology
PWI and DWI Can Image Cerebral Ischemic Lesions
The combination of early diffusion-weighted MRI (DWI) and perfusion-weighted MRI (PWI) can detect the presence of a cerebral ischemic lesion in 51 percent of patients who present with a suspected hemispheric transient ischemic attack (TIA). These findings are based on a study conducted by Stanford University Prof. M. Mlynash and colleagues that focused on the performance of PWI and DWI within 48 hours of symptom onset in consecutive patients admitted with suspected hemispheric TIAs of less than 24 hours' symptom duration.
From "Yield of Combined Perfusion and Diffusion MR Imaging in Hemispheric TIA"
Neurology (04/01/2009) Mlynash, M.; Olivot, J-M; Tong, D.C.
Researchers Develop a Logistic Regression Model to Aid Breast Cancer Diagnosis
Researchers, led by Dr. Jagpreet Chhatwal of the University of Wisconsin Department of Radiology, have developed a logistic regression model that can effectively discriminate between benign and malignant breast disease and can identify the most important features associated with breast cancer. Chhatwal and colleagues created two logistic regression models based on the mammography features and demographic data for 62,219 consecutive mammography records from 48,744 studies in 18,270 patients reported using the Breast Imaging Reporting and Data System (BI-RADS) lexicon and the National Mammography Database format. Cancer probability was established as the outcome for both models. Model 2 was then built using all variables in Model 1 in addition to radiologists' BI-RADS assessment categories. That model was then tested using 10-fold cross validation, while performance was measured by calculating the areas under the receiver operating characteristic curves.
From "A Logistic Regression Model Bases on the National Mammography Database Format to Aid Breast Cancer Diagnosis"
American Journal of Roentgenology (04/01/2009) Vol. 192, No. 4, P. 1117; Chhatwal, Jagpreet; Alagoz, Oguzhan; Lindstrom, Mary J.
Medical-Legal Issues
Congress Hears Arguments for a Clean Slate on Medicare Payment Formula
The American Medical Association (AMA) and other physician organizations are urging Congress to embrace a new, more realistic budgetary baseline for doctors' Medicare pay so that they can more accurately project spending and make a move toward fixing the problem of the sustainable growth rate (SGR) formula. "Re-basing is a smart, realistic and transparent approach to addressing rising health care costs because it allows accurate forecasts of what those costs are going to be," stated AMA Board of Trustees Chair Joseph M. Heyman, MD, at a hearing of the House Committee on Small Business. The re-basing concept was aided in late February by President Obama, who included in his fiscal 2010 budget proposal the assumption that correcting Medicare pay would cost $330 billion over a decade. Even if Congress re-based the SGR, it would still need to reform or repeal the system via new legislation. American College of Physicians President Jeffrey P. Harris, MD, warned at the House hearing that concealing the costs of halting the pay cuts merely delays rather than eliminates them, which raises the actual cost of the next patch. "President Obama's budget is a marked departure from past practices because it acknowledges what we all know to be true, which is that preventing pay cuts to doctors will require that Medicare baseline spending be increased accordingly," he testified. Heyman said that a more permanent payment solution would be particularly beneficial for doctors who operate their practices as small businesses that cannot absorb the precipitous losses forecast under the present SGR formula. He contended that a major retooling of the pay system is required this year to guarantee that senior citizens have access to medical care in the long term. "We need to find ways to keep practicing physicians caring for seniors and encourage the best and brightest students to become physicians," Heyman noted. "Permanent Medicare physician payment reform will help us achieve that goal."
From "Organized Medicine Pushes Congress for Clean Slate on Medicare Payment Formula"
American Medical News (03/30/09) Silva, Chris
Stimulus Package Provides Incentives for EMR Adoption
The economic stimulus package provides $44,000 to $64,000 to physicians who acquire and can demonstrate "meaningful use" of a "certified" electronic medical record (EMR) over the next five years. However, any physicians who still are not using a certified EMR after the expiration of the five-year period will face cuts in their Medicare payments. An Allscripts poll estimates that 68 percent of physicians say they would probably participate in a pay-for-purchase program, while 37 percent of surveyed physicians are already participating in such a program. A Congressional Budget Office analysis finds that the "incentive mechanism would boost ... adoption rates to about 70 percent for hospitals and about 90 percent for physicians" by 2019. Critics are concerned that the $44,000-and-up per-physician payment may be insufficient, and SRS Soft CEO Evan Steele argues that "the price [of the software] is dwarfed by the problems it [an EMR] causes the office." Rob Tennant with the Medical Group Management Association's government affairs office counters that properly deployed EMR can improve productivity when coupled with proper training for staff and doctors. The government wants to make it possible for physicians to access every patient's records on an as-needed basis, no matter where or by whom the patient was treated, and regardless of the patient's insurance carrier or the physician's EMR vendor.
From "What's in the Stimulus Package for Physicians?"
Physicians Practice (04/09) Moore, Pamela
Clinical Practice
Radiologists Must Consider Certain Factors When Imaging Pregnant Patients With Suspected Pulmonary Embolism
There currently are no widely accepted guidelines for radiologists for the use of diagnostic imaging in the diagnosis of pulmonary embolism (PE) during pregnancy. However, Dr. Jay K. Pahade of the Harvard Medical School Department of Radiology and colleagues stress the importance of imaging when attempting diagnosis of PE in pregnant women, particularly because classic clinical symptoms often are absent and physiologic changes during pregnancy can mimic PE. Therefore, in order to ensure imaging can be used safely and effectively in these situations, Pahade and his team maintain that radiologists must be familiar with the advantages and disadvantages of available imaging modalities. Additionally, radiologists should consider methods of dose reduction, radiation risks, and medicolegal risk management guidelines before using any type of scan to diagnose PE in pregnant women.
From "Imaging Pregnant Patients With Suspected Pulmonary Embolism: What the Radiologist Needs to Know"
Radiographics (03/09) Pahade, Jay K.; Litmanovich, Diana; Pedrosa, Ivan
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