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Research
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Clinical Practice
From RSNA
April RSNA News Now Online
The full version of the April issue of RSNA News is now available online.
Highlights include:
Medicine Not "Bulletproof" in Recession
While radiology demand, particularly in acute care medicine, remains steady, physicians are taking precautions to protect themselves from the effects of the U.S. economic downturn.
IHE® Connectathon Gives EHRs Momentum
This year's Integrating the Healthcare Enterprise (IHE) Connectathon offered a glimpse of new device profiles, progress in partnerships and the promise of achieving a universal electronic health record (EHR) in the next few years.
New Studies Show Potential for Dramatically Improved MR
The future of MR imaging may be dramatically improved images and more flexibility in how patients are imaged, new studies indicate.
SPECT/CT Improves Thyroid Cancer Staging
A breakthrough in lymph node imaging in thyroid cancer using hybrid single photon emission CT and CT (SPECT/CT) has led to better assessment of recurrence risk and staging for treatment, according to German researchers.
R&E Grant Provides First Step in Years of Funded Research
It may have been more than 20 years since Janet F. Eary, M.D., earned her first research grant - an RSNA Research Seed Grant - but while the details of the project are fuzzy, Dr. Eary is certain the RSNA grant was a stepping stone to the millions of dollars in subsequent funding she has received.
New! Speak Up and Listen In
Making their debut this month are two RSNA News online features. Register your opinion on a hot topic with the new Speak Up reader poll. With the new Listen In audio segments, hear what radiology leaders are saying about some of the specialty's most important issues.
Leading the News
Medicare Expands Coverage of PET Scans as Cancer Diagnostic Tool
The Centers for Medicare and Medicaid Services (CMS) has released a final national coverage determination that will expand coverage for initial testing with positron emission tomography (PET) for Medicare beneficiaries who are diagnosed with and treated for most solid tumor cancers. By doing so, CMS removes the requirement to report PET scans for these cancers to the National Oncologic PET Registry. The decision applies to PET scans used to support initial diagnosis and treatment for most types of solid tumor cancers, including breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung, and thyroid cancers. Additionally, coverage will be expanded to PET scans for subsequent follow-up testing in beneficiaries who have cervical or ovarian cancer, or who are being treated for myeloma.
From "Medicare Expands Coverage of PET Scans as Cancer Diagnostic Tool"
CMS Press Release (04/06/09)
Research
IMRT Reduces Radiation Dose and Improves Health-Related Quality of Life
Use of intensity-modulated radiation therapy (IMRT) can lead to a significant reduction of observer-rated xerostomia and other head and neck symptoms when compared to standard, three-dimensional conventional radiotherapy (3D-CRT). This conclusion is based on a 241-patient study conducted by Dr. Marije R. Vergeer of the VU University Department of Radiology and colleagues. The participants all had head and neck squamous cell carcinoma and had been previously treated with bilateral irradiation and chemotherapy. Prior to October 2004, 150 patients were treated with 3D-CRT, while 91 patients also received IMRT after clinical implementation of the study. The researchers found that the use of IMRT led to a significant decrease in the mean dose of the parotid glands, and they noted that IMRT treatment also had a positive effect on a number of general and head and neck cancer-specific health-related quality-of-life factors.
From "Intensity-Modulated Radiotherapy Reduces Radiation-Induced Morbidity and Improves Health-Related Quality of Life …"
International Journal of Radiation Oncology, Biology, Physics (05/09) Vol. 74, No. 1, P. 1; Vergeer, Marije R.; Doornaert, Particia A.H.; Rietveld, Derek H.F.
PET Demonstrates Reduced Dopamine Transporter Expression in PD With Dyskinesias
Dr. Andre R. Troiano of the Pacific Parkinson's Research Centre, in Vancouver, British Columbia, and colleagues recently were able to use positron emission tomography (PET) to identify causes of dyskinesias in patients with Parkinson disease (PD). Over the course of the study, the researchers used PET with C-d-threo-methylphenidate an C-+dihydrotetrabenazine to identify presynaptic alterations that contribute to the appearance of dyskinesias in patients with PD. The study included 36 patients with PD, 27 of whom had dyskinesias and nine who had motor fluctuations without dyskinesia.
From "PET Demonstrates Reduced Dopamine Transporter Expression in PD With Dyskinesias"
Neurology (04/07/2009) Vol. 72, No. 14, P. 1211; Troiano, A.R.; de la Fuente-Fernandez, R.; Sossi, V.
Hypervascular Liver Tumors: Low Tube Voltage, High Tube Current Multidetector CT During Late Hepatic Arterial Phase for Detection
New research has found that a low tube voltage, high tube current CT technique improves the conspicuity of malignant hypervascular liver tumors during the late hepatic arterial phase while significantly lowering the patient radiation dose. According to the prospective, single-center study, led by Dr. Daniele Marin of the Duke University Medical Center Department of Radiology, the technique is able to do so by substantially increasing the tumor-to-liver contrast-to-noise ratio (CNR). The researchers performed dual-energy 64-section multi-detector row CT on 48 patients with 60 malignant hypervascular liver tumors. The researchers then developed two imaging protocols -- protocol A: 140 kVp and 385 mA, and protocol B: 80 kVp and 675 m A. Paired t tests then were used to compare tumor-to-liver CNR for all lesions using both protocols, and three readers assessed the data sets. The study was published in Radiology.
From "Hypervascular Liver Tumors: Low Tube Voltage, High Tube Current Multidetector CT During Late Hepatic Arterial Phase for Detection"
Radiology Online (04/03/09) Marin, Daniele; Nelson, Rendon C.; Ehsan, Samei
Technology
FDG-PET Is Sufficiently Sensitive for Whole-Body Cancer Screening When Combined With Other Modalities
Fluorodeoxyglucose positron emission tomography (FDG-PET) alone is not sufficiently sensitive for full-body cancer screening. However, when combined with other appropriate modalities, FDG-PET may be useful for the detection of a wide variety of early-stage cancers, according to research conducted by Dr. Sadahiko Nishizawa and others. Over the course of three cancer screenings, the researchers used FDG-PET and abdominal CT, brain and pelvic MRI, several tumor markers, and fecal occult blood testing to detect cancers in a total of 1,197 healthy volunteers. At the end of 2006, 22 primary cancers had been pathologically confirmed. Of these cancers 19 were detected by the screening and three were diagnosed only after the development of symptoms. Additionally, the screening detected many indolent cancers and false positives, leading researchers to conclude that further study is necessary.
From "Prospective Evaluation of Whole-Body Cancer Screening With Multiple Modalities Including Fluorodeoxyglucose Positron Emission Tomography in …"
Journal of Clinical Oncology (04/09) Vol. 27, No. 11, P. 1767; Nishizawa, Sadahiko; Kojima, Shinsuke; Teramukai, Satoshi
DE-MRI Provides Non-Invasive Method for the Detection and Qualification of Left Atrial Structural Remodeling
University of Utah Professor Robert S. Oakes and his team recently found that delayed-enhancement MRI (DE-MRI) provides a non-invasive means of assessing left atrial myocardial tissue in patients suffering from atrial fibrillation (AF). The clinical trial included 81 patients presenting for pulmonary vein antrum isolation for treatment of AF. All participants underwent three-dimensional DE-MRI of the left atrium before ablation. Six healthy volunteers also were scanned. On the basis of pre-ablation enhancement, 43 patients were classified by DE-MRI as having minimal enhancement, while 30 had moderate enhancement and eight had extensive enhancement. Based on their findings, the researchers concluded that DE-MRI may hold promise for predicting responders to AF ablation and may provide a metric of overall disease progression.
From "Detection and Qualification of Left Atrial Structural Remodeling With Delayed-Enhancement Magnetic Resonance Imaging in Patients With Atrial ..."
Circulation (04/07/09) Vol. 119, No. 13, P. 1758; Oakes, Robert S.; Badger, Tory J.; Kholmovski, Eugene G.
PLHS Improves Detection of Hippocampal Sclerosis in MTLE
Partial loss of the hippocampal striation (PLHS) at 3.0 T is more sensitive than conventional MR imaging methods when detecting hippocampal sclerosis in medial temporal lobe epilepsy (MTLE), according to a recent study led by Dr. Mai Hanamiya of the University of Occupational and Environmental Health School of Medicine Department of Radiology in Japan. For the study, researchers retrospectively evaluated both fluid-attenuated inversion-recovery (FLAIR) MRI and T2-weighted MRI on 22 consecutive patients diagnosed with MTLE and 15 age-matched controls. Two radiologists then independently reviewed the MRI imaging findings of the hippocampus regarding atrophy, abnormal signal intensity, and PLHS on each side separately, without comparing both sides. Sensitivity and specificity were calculated among the MRI imaging findings. The researchers found that PLHS on T2-weighted MRI images had a sensitivity of 76 percent for the diagnosis of hippocampal sclerosis, while signal intensity abnormality on FLAIR images had a sensitivity of 36 percent. The study was published in Radiology.
From "Partial Loss of Hippocampal Striation in Medial Temporal Lobe Epilepsy"
Radiology Online (04/03/09) Hanamiya, Mai; Korogi, Yukunori; Kakeda, Shingo
Medical-Legal Issues
Obama Budget Makes No Assumptions About Medicare Sustainable Growth Rate Cuts
The $3.5 trillion spending plan passed by the U.S. House and Senate reflects the recent reality of applying the Medicare sustainable growth rate policy on physician fees, anticipating that once again Congress will intervene to head off the pending 21 percent cut to physician fees next year. The spending plan actually forecasts that payments will increase by $147.1 billion from 2010 to 2014. The American Medical Association (AMA) voiced its support of the administration's handling of sustainable growth rates (SGR). An anonymous AMA official asserted that
the omission of SGR's impact in the president's budget is a "big step forward toward permanent reform." Although
the absence of cuts in the budget does not reveal the president's position on SGR, it sets the stage for congressional action, the official said. Orrin Marcella, the American College of Radiology's director of congressional affairs, said the treatment of SGR is an outgrowth of Obama's emphasis on transparency for his $3.5 trillion proposal. "The president is not making policy. He is making a budget that reflects reality," Marcella said. "A policy change is up to Congress."
From "Obama Budget Makes No Assumptions About Medicare Sustainable Growth Rate Cuts"
Diagnostic Imaging (04/03/09) Brice, James
Physician's Organizations Ask FTC to Reconsider New Identity Theft Requirements
Medical societies are locked in dispute with the Federal Trade Commission (FTC) over new identity theft prevention rules' application to physicians, and the compliance date of May 1 is fast approaching. The FTC rules demand that various business entities, primarily in finance and banking, have written programs for preventing, detecting, and responding to identity theft. However, the American Medical Association (AMA) and other medical societies have raised objections to a lack of forewarning and what they believe is unreasonable breadth of application. AMA Secretary Ardis D. Hoven, MD, says that the FTC "did not give physicians an appropriate opportunity for notice and comment on the ruling that the red flags would be applied to them. The AMA is calling on FTC to re-publish its rule so that we can make the case that physicians should be excluded." The rules were mandated under the 2003 Fair and Accurate Credit Transactions Act, but it was not until last summer that physicians learned they would need to comply as well; the FTC responded by extending the Nov. 1 compliance deadline to May 1, but the commission says there will be no more extensions. Medical societies are questioning the FTC's viewpoint that physicians' practice of billing patients after the completion of services means that physicians are creditors. The Medical Group Management Association has also raised concerns that if physicians are considered creditors for the purposes of this rule, then other additional regulations having nothing to do with health care may end up applying to them as well. On the plus side, the existing HIPAA policies at physician practices should give them a head start in implementing the new rules, and the AMA is planning to release physician guidance on the matter by April 10.
From "Medicine Slams FTC Over Forcing Physicians to Police Identity Theft"
American Medical News (04/06/09) Sorrel, Amy Lynn
Clinical Practice
FDA Provides Recommendations to Prevent Adverse Events Associated With Sandbags in the MRI Suite
The FDA has issued a warning asking all radiologists and other staff working in the MRI suite to ensure they do not allow sandbags that may contain ferromagnetic material near the MRI equipment. This warning follows a report of a patient who underwent MR imaging while she had a sandbag on her groin to help facilitate hemostasis following a procedure to repair a femoral artery puncture. As the procedure began, the sandbag, which was found to contain ferromagnetic iron shavings and pellets, was pulled into the MRI coil, which did not injure the patient but did damage the equipment. To mitigate the risk of this type of event in the future, the FDA has published several recommendations. First, facilities are encouraged to purchase sandbags that are labeled MR Safe or MR Conditional, while any sandbags that do contain ferromagnetic material should be labeled MR Unsafe. Any unlabeled sandbags should not be permitted into the MRI suite. All MRI staff should screen patients for ferromagnetic objects. Additionally, they should check patient medical records to detect any recent procedures, such as cardiac catheterization, that may have required the use of a sandbag.
From "Danger: 'Sandbag' in the MRI Room"
FDA.gov (04/02/09) Gallauresi, Beverly Albrecht
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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