Quality Improvement Storyboard Abstracts Due June 15
RSNA is accepting abstracts describing quality assessment and improvement in radiology for possible display in the Quality Storyboard section of the Lakeside Learning Center at RSNA 2009.
The deadline is midnight CDT on June 15.
Abstracts should describe quality initiatives undertaken to improve care or services to patient. Authors of chosen projects must be available to speak in person with meeting attendees about their projects for at least one 30-minute session during the annual meeting.
For more information, go to RSNA.org/quality/storyboards.
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Leading the News
Senate Finance Committee Backs Financial Penalties for Physicians Performing Excessive Inappropriate Scans
The Senate Finance Committee has released a report that supports financial penalties for physicians who are found to frequently recommend inappropriate medical imaging procedures. There are a number of specific provisions in the report—which could prove influential in the creation of future legislation—designed to target physician self-referral and inappropriate utilization. If the report's proposals are accepted, they would amend the in-office ancillary services exception to the federal self-referral law so that it requires physicians to disclose to patients any financial interest they have in imaging services in their offices. The report also supports the adoption of appropriateness criteria for high-tech imaging. That criteria would be used to create a new sliding scale for payments, with financial penalties in the form of lower rates for facilities and physicians who order excessive numbers of inappropriate imaging procedures. The proposal recommends the creation of a new imaging information organization that would share information about the use of imaging services and assist physicians in minimizing duplicative scans and radiation exposure to patients. Additionally, the proposal includes plans for the creation of five regional Diagnostic Imaging Exchange Networks, designed to help physicians evaluate the necessity, safety, and appropriateness of imaging procedures.
From "Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs"
Senate Finance Committee (04/29/2009)
Research
ASL-MRI Detects Cerebral Perfusion Differences in Patients With RDD and NDD
Arterial spin labeling (ASL) MR imaging was able to detect differences between cerebral perfusion in patients with refractory depressive disorder (RDD) and nonrefractory depressive disorder (NDD) as part of a study published in the May issue of Radiology. The study, conducted by Dr. Su Lui of the Huaxi MR Research Center in China and colleagues from England and China, included 24 patients with RDD, 37 patients with NDD, and 42 healthy controls who were imaged with a 3-T MR system. ASL and echo-planar images were subtracted and averaged to give perfusion-weighted images. This process revealed alterations of regional perfusion in the brains of patients with RDD that differed from those in patients with NDD.
From "Depressive Disorders: Focally Altered Cerebral Perfusion Measures With Arterial Spin-Labeling MR Imaging"
Radiology Online (05/01/09) Lui, Su; Parkes, Laura M.; Huang, Xiaoqi
Whole-Body CT During Trauma Resuscitation Improves Survival
Researchers working on behalf of the Working Group on Polytrauma of the German Trauma Society compared the probability of survival in patients with blunt trauma who had whole-body CT during resuscitation with those who did not. The researchers used data recorded in the trauma registry of the German Trauma Society to calculate the probability of survival according to the trauma and injury severity score (TRISS), revised injury severity classification (RISC) score, and standardized mortality ratio (SMR, ratio of recorded to expected mortality) for 4,621 patients with blunt trauma given whole-body or non-whole-body CT. The researchers found that the inclusion of whole-body CT in early trauma care significantly increased the probability of survival in patients with polytrauma, recommending the use of whole-body CT as a standard diagnostic method during the early resuscitation phase for patients with polytrauma.
From "Effect of Whole-Body CT During Trauma Resuscitation on Survival: A Retrospective, Multicentre Study"
Lancet (04/25/09) Vol. 373, No. 9673, P. 1455; Huber-Wagner, Stefan; Lefering, Rolf; Qvick, Lars-Mikael
Thin-Section CT Findings May Not Represent Clinically Relevant Lung Disease
Thin-section CT findings usually associated with lung disease are also frequently present in asymptomatic adults over the age of 75 years. This conclusion was reached by Dr. Susan J. Copley from the Department of Radiology at Hammersmith Hospital in London, England, and colleagues, who cautioned that thin-section findings may not represent clinically relevant disease. The full study, which can be found in the May issue of Radiology, included 56 volunteers, with 40 over the age of 75 and 16 under the age of 55. Copley and her team performed prone thin-section CT on all participants. Two observers then independently scored images for the presence and extent of CT features, including reticular pattern, ground glass opacity, and thin-walled cystic air spaces. Logistic regression analysis was used to assess relationships between the CT findings, age, and smoking history.
From "Lung Morphology in the Elderly: Comparative CT Study of Subjects Over 75 Years Old Versus Those Under 55 Years Old"
Radiology Online (05/01/09) Copley, Susan J.; Wells, Athol U.; Hawtin, Katherine E.
Technology
Computer Engineers Develop an Ultrasound Device That Can Be Plugged Into Smart Phones
Computer engineers at Washington University in St. Louis have developed an ultrasound device that can be plugged directly into a smart phone's USB port. The device enables smart phones to capture images and display them directly on the phone's screen. The phone can also be used to send the images to other users. Washington University researchers William Richard and David Zar created the smart phone device from an ultrasound probe they had previously developed that can plug into a laptop's USB port. The researchers transferred all of the necessary computing power to the probe and decreased its power consumption to only half a watt. The image the device creates is smaller and of a lower quality than the laptop version, but the researchers believe that it is more than sufficient for many medical applications. The researchers say it could be used in remote rural communities and developing nations as well as for emergency imaging of patients en route to a hospital. They also say it could be used for battlefield medicine and for home use by patients with chronic illnesses. Zar plans to have open source software available this summer.
From "Ultrasound to Go"
Technology Review (04/23/09) Gravitz, Lauren
Diffusion Tensor Imaging Allows Radiologists to See Areas of the Brain Rarely Seen Using Other Imaging Modalities
Diffusion tensor imaging (DTI), a technique that measures diffusion in a series of different spatial directions, allows radiologists to look at parts of the brain that are rarely visible with any other imaging method, according to a study performed at Beth Israel Deaconess Medical Center in Boston, Mass. "We used DTI to evaluate the white matter anatomy (layer found beneath the outer layer of the brain)," says Fargol Booya, MD, lead author of the study. "Based on the pattern of color changes, we could somewhat predict whether white matter tracts were displaced. Evaluation of white matter anatomy is usually not possible with any other imaging method. Tumor (21 patients), hemorrhage (15 patients) and infarction (27 patients) had different manifestations on DTI." Booya added that the method "offers an overall view of brain anatomy, including the degree of connectivity between the different regions of the brain." The study was scheduled to be presented at the April 26-30 annual meeting of the American Roentgen Ray Society in Boston.
From "Diffusion Tensor Imaging Allows Radiologists to See Areas of the Brain Rarely Seen Using Other Imaging Modalities"
Medical News Today (04/24/09)
Medical-Legal Issues
Insurer Wants Boost for Primary Care at Imaging's Expense
During a congressional hearing on healthcare reform held by the U.S. Senate Finance Committee, the Blue Cross Blue Shield Association suggested increasing payments to primary care physicians by cutting payments for imaging services. "Escalating costs are the main reason people are unable to obtain health insurance, and rising healthcare costs must be addressed through delivery system reforms that increase quality and enhance value," said Blue Cross Blue Shield's Allan Korn at an April 21 roundtable discussion held by the committee. Such reforms involve switching Medicare from a fee-for-service design to a fee-for-performance model. Korn said that boosting payments to primary care physicians while fortifying the primary care workforce is crucial to building momentum for reforms. "Paying for this could be done primarily by reducing payments for imaging services to providers who rely heavily on costly imaging machines," he noted.
From "Insurer Wants Boost for Primary Care at Imaging's Expense"
Diagnostic Imaging (04/24/09) Abella, H.A.
Institute of Medicine Asks Physicians to Stop Accepting Drug and Device Company Gifts
The Institute of Medicine is calling on doctors to stop accepting gifts from drug and device companies in a new report. "It is time for medical schools to end a number of long-accepted relationships and practices that create conflicts of interest, threaten the integrity of their missions and their reputations, and put public trust in jeopardy," the Institute of Medicine study argues. The report also urges the U.S. Congress to pass laws mandating that drug and device makers publicly disclose all payments made to doctors. Sen. Charles E. Grassley (R-Iowa), who has co-sponsored legislation demanding such disclosure with Rep. Herb Kohl (D-Wis.), says that "it's a shot in the arm to the reform movement to have the prestige and policy heft of the Institute of Medicine on the side of transparency." Drug and device makers currently supply about 50 percent of the funding for medical refresher courses so that doctors can often take them free of charge, and many medical societies and schools have deemed subsidies for education to be necessary. However, Kohl says that an investigation has turned up evidence that some refresher courses show bias toward the sponsoring device or drug company.
From "Institute of Medicine Calls for Doctors to Stop Taking Gifts From Drug Makers"
New York Times (04/29/09) Harris, Gardiner
Clinical Practice
American Academy of Pediatrics Releases Policy Statement Regarding Diagnostic Imaging of Child Abuse
The role of imaging in cases of child abuse is to identify the extent of physical injury when abuse is present and explain any imaging findings that may indicate alternative diagnoses. The strongest radiological indicator of abuse is skeletal trauma, and dating of skeletal injuries can provide investigators with a time frame in which the abuse likely occurred, helping identify potential assailants. In most cases, a radiographic skeletal survey is the method of choice for global skeletal imaging in cases of suspected abuse. Standards for skeletal survey imaging recommend that radiologists use low-dose imaging systems to detect potential chest and abdominal injuries. However, they note that low-dose modalities often lack the necessary contrast and spatial resolution to image subtle metaphyseal, rib, and other high-specificity injuries. In order to detect these injuries, high-detail imaging systems should be used in infancy without an antiscatter grid. Beyond infancy, faster, general-purpose systems are required for thicker body regions. Once the appropriate imaging system has been selected, radiologists should develop a precise protocol for skeletal imaging. In addition to skeletal imaging, all infants with suspected intracranial injury must undergo cranial CT, MRI, or both. Strategies should be directed toward the detection of all intracranial sequelae of abuse and neglect. Initial studies should focus on rapid detection of treatable injuries while subsequent studies should be designed to determine the timing of all injuries and monitor their evolution.
From "Diagnostic Imaging of Child Abuse"
Pediatrics (05/09) Vol. 123, No. 5, P. 1430; Di Pietro, Michael A.; Brody, Alan S.; Cassady, Christopher I.
New Website Calculates Cancer Risk From Medical Imaging
A new Web site, www.xrayrisk.com, allows radiologists to calculate patients' lifetime increased risk of cancer based on the CT scans or x-rays performed. The host of the Web site, Michael Hanley, MD, a second-year radiology resident at the Medical University of South Carolina, says, "Every time I open the paper I see an article on radiation risk. Many news reports make inflammatory claims that are scary for patients. What we tried to do was get real numbers out there with facts about radiation and cancer and how much radiation is involved with different types of medical imaging studies." The site features a calculator allowing physicians to pick a study and enter a patient's age and gender. The additional risk of cancer based on the radiation exposure from the medical tests reviewed in the study is then calculated.
From "New Website Calculates Cancer Risk From Medical Imaging"
Dotmed (04/22/09) Kram, Barbara
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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