RadiologyInfo Launches “Your Radiologist Explains”
Chest X-ray, pediatric radiology and abdominal CT are some of the procedures described on “Your Radiologist Explains,” the newest feature of RadiologyInfo.org, the RSNA/American College of Radiology site for educating the public on radiologic procedures. The feature pairs PowerPoint presentations with audio clips to offer patients a new medium for learning about radiology procedures.
Click here to watch the chest X-ray feature.
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Leading the News
President's FY 2010 Budget for FDA Substantially Increases Investment in Medical Product Safety
The U.S. Food and Drug Administration (FDA) is requesting a budget of $3.2 billion as part of the President's budget for fiscal year 2010, a 19 percent increase over the current FDA fiscal year budget. Of this funding, $166.4 million would be put towards the FDA's new Safer Medical Products initiative, which is designed to improve the safety of medical devices as well as other medical products for human and animal use. According to the FDA, the initiative will allow the agency to strengthen the safety and security of the supply chain for medical products. For example, the initiative includes new fees charged to medical product manufacturers whose facilities must be reinspected because they failed to meet safety standards.
From "President's FY 2010 Budget for FDA Invests Substantially in Food and Medical Product Safety"
FDA.gov (05/07/09)
Research
US and MRI Detect Cerebellar Injury in Preterm Infants
Sylke J. Steggerda, MD, and colleagues from the Leiden University Medical Center in Leiden, the Netherlands, recently found that cranial ultrasonography (US) through the mastoid fontanelle (MF) can detect cerebellar injury in preterm infants that is often missed by using the routine anterior fontanelle (AF). The study, published online in Radiology, included a cohort of 77 preterm infants examined with serial cranial US throughout the neonatal period using the AF and MF views as well as the posterior fontanelle view. MR imaging was then performed on 59 of the infants as a reference standard.
From "Cerebellar Injury in Preterm Infants: Incidence and Findings on US and MR Images"
Radiology Online (05/06/09) Steggerda, Sylke J.; Leijser, Lara M.; Wiggers-de Bruïne, Francisca T.
Digital Mammography Reduces Adverse Effects of Screening Programs
Digital mammography may reduce the adverse effects of screening programs; however, the technique must still be confirmed as having the same diagnostic accuracy as screen-film mammography. This conclusion was based on a study by Maria Sala, MD, PhD, and colleagues at the IMIM-Hospital del Mar in Barcelona, Spain, that was published online in Radiology. Sala and colleagues compared data from 12,958 women between the ages of 50 and 69 years who participated in a screening round before the introduction of digital mammography as well as data from 6,074 women who participated in screening after the introduction of digital mammography. Overall recall rates for screen-film and digital mammography groups were 5.5 percent and 4.2 percent, respectively. Primary factors related to the risk of recall were screen-film mammography group, first screening round, menopausal status, and personal history of benign breast disease.
From "Implementation of Digital Mammography in a Population-Based Breast Cancer Screening Program: Effect of Screening Round on Recall Rate and Cancer Detection"
Radiology Online (05/06/09) Sala, Maria; Comas, Mercè; Macià, Francesc
Lithium Helps Radiation Target Cancer, Spare Healthy Tissue
Researchers at Vanderbilt-Ingram Cancer Center at the Vanderbilt University School of Medicine in Nashville, Tenn., have found a mechanism that helps explain how lithium can protect the brain from radiation-treatment damage of the sort that may lead to reduction in performance IQ, learning difficulties, and memory loss, particularly in children treated for brain cancers. The effects of these impairments on survivors' quality of life is long-lasting, says researcher Fen Xia, MD, PhD, an assistant professor of radiation oncology and cancer biology. "Because these patients can now survive longer and are being cured, alleviating long-term toxicity is becoming more important." While lithium did not prevent the generation of chromosomal double-stranded breaks (DSBs) that sever both strands of a DNA double helix, the researchers found that it promoted the most common repair mechanism used in normal neurons, known as nonhomologous end-joining (NHEJ). Evidence showed that radiation-induced DSBs were repaired more efficiently in lithium-treated cells through the NHEJ pathway, while these effects were not seen in malignant glioma cells, which Xia suggests is because cancer cells tend to use a different DNA repair mechanism.
From "Lithium-Mediated Protection of Hippocampal Cells Involves Enhancement of DNA-PK-Dependent Repair in Mice"
Journal of Clinical Investigation (05/01/2009) Vol. 119, No. 5, P. 1124; Yang, Eddy S.; Wang, Hong; Jiang, Guochun
MR Angiography Identifies Possible Clubfoot and Vertical Talus Etiologies
In this study, researchers led by Lisa Kruse used magnetic resonance (MR) angiography to define the lower extremity vascular anatomy of two patients with left-sided vertical talus and right-sided clubfoot and one patient with bilateral vertical talus and cartilage-derived morphogenetic protein-1 (CDMP-1) gene mutation. For the first two patients, the MR angiography showed that one had bilateral posterior tibial artery deficiencies and the other had bilateral anterior tibial artery deficiencies, while the patient with bilateral vertical talus and CDMP-1 mutation had normal arterial structure bilaterally. Though clubfoot and vertical talus have distinctly different clinical phenotypes, the association of each with arterial abnormalities suggests a common etiology during development. The researchers concluded that the presence of normal arterial structure in the patient with vertical talus and CDMP-1 mutation suggests that other nonvascular etiologies may be responsible for some cases of foot deformities.
From "Magnetic Resonance Angiography in Clubfoot and Vertical Talus: A Feasibility Study"
Clinical Orthopaedics and Related Research (05/01/09) Vol. 467, No. 5, P. 1250; Kruse, Lisa; Gurnett, Christina; Hootnick, David
Researchers Identify Predictor of MS Progression
Researchers at the University of California at San Francisco (UCSF) have found a link between elevated levels of glutamate in the brain and greater disease burden in patients with multiple sclerosis (MS), pointing the way toward a better way to track and predict the disease. The team measured clinical trial patients' glutamate levels using a proton MR spectroscopy-based technique developed by Radhika Srinivasan, an assistant researcher at the UCSF Department of Radiology and Biomedical Imaging. "This is the first time that we have had the ability to measure glutamate toxicity in the brain in real time, which gives us a marker for monitoring disease progression as well as our treatment of the disease," says Dr. Daniel Pelletier, associate professor of neurology and a member of the Multiple Sclerosis Research Group at UCSF. "For instance, we already have anti-glutamate drugs, so now we can assess, with imaging, the impact of the therapy and the progression of the disease." The study, which the authors say is the largest-ever clinical analysis of metabolism byproducts in the brain, was presented during the American Academy of Neurology annual scientific meeting in Seattle.
From "Predictor of Multiple Sclerosis Progression Identified"
eMaxHealth.com (05/04/09)
Technology
Diffusion-Weighted Imaging Improves Accuracy of Breast MRI
New research indicates that diffusion-weighted imaging (DWI) is a helpful way to distinguish malignant and benign breast lesions during an MRI and may cut down on unneeded breast biopsies. DWI makes use of the different rates of water molecule diffusion that are seen in pathologic tissue versus normal tissue, helping improve the specificity rates for detecting breast cancer lesions in an MRI. R. El-Khouli, MD, of the National Institutes of Health, who led the study when she was at the Johns Hopkins University School of Medicine, presented the study results in Boston at the recent American Roentgen Ray Society (ARRS) 2009 Annual Meeting, saying the primary motivation was to prevent unnecessary breast biopsies. "We are hoping to improve the specificity of MRI by adding new techniques like DWI and spectroscopy," she said. Her study looked at 81 patients with 85 lesions, with 60 lesions already known to be malignant and 25 known to be benign. The DWI/MRI technique she developed correctly diagnosed 83 percent of the known malignant lesions as well as 92 percent of the known benign lesions. "This technique currently is a compromise," El-Khouli said. "You don't want to miss a single cancer. At the same time you don't want to get women into the trouble of having biopsies and introducing unnecessary concern. It is a very challenging task." The moderator of the conference session, Lonie Salkowski, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, said, "DWI will be a helpful technique but there are a lot of things that need to be hashed out." According to Salkowski, "There is no tool to foster ease of use like what we have with other techniques, like computer-aided detection. It is one of its limitations because everyone makes their own ad hoc system of how to do it. I think in certain cases you can use it if you are really suspicious of the lesion and want to gain more information without committing to biopsy. It has some potential, but it needs more work in terms of refining the technique as well as in interpreting the results." El-Khouli and her colleagues are working on automating the processing of normalized apparent diffusion coefficient values for the entire breast.
From "ARRS 2009: Diffusion-Weighted Imaging May Improve Accuracy of Breast MRI"
Medscape (05/04/09) McCarthy, Alice
Clinical Practice
CTA Improves Patient Management in the Emergency Department
Coronary CT angiography (CTA) allows early triage of patients with acute chest pain, according to a study by researchers at the Harvard Medical School and Tufts University School of Medicine in Boston, Mass., and University of Erlangen in Erlangen, Germany. The study included 368 patients who were admitted with low to intermediate risk for acute coronary syndrome (ACS). Of those patients, 8 percent were found to have ACS. Following CTA, 50 percent of those patients were found to be free of coronary artery disease while 31 percent had nonobstructive disease and 19 percent had inconclusive or positive CT for significant stenosis. None of the patients without plaque had ACS, and many patients had plaque but no ACS. Based on these findings, the researchers concluded that all patients with acute chest pain in which CTA does not detect plaque or stenosis can be safely discharged from the emergency department provided they do not have any electrocardiogram or troponin abnormalities.
From "Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain"
Journal of the American College of Cardiology (05/05/2009) Vol. 53, No. 18, P. 1642; Hoffmann, Udo; Bamberg, Fabian; Chae, Claudia U.
Doctors Should Minimize Scans That Expose Young Patients to Radiation
Research from the Johns Hopkins Children's Center indicates that doctors should use a minimal number of scans that expose children to radiation, as radiation exposure is a risk factor for cancer later in life and children are thought to be more vulnerable to radiation's effects. The study, which followed children who received imaging exams, including CT scans and X-rays, during emergency room and hospital evaluation, found that the average radiation dose was close to 13 mSv, and the highest dose was 75 mSv—much higher than the 3 mSv per year that the average American is exposed to in the environment. The researchers looked through a one-year set of medical records and examined 945 patients' charts, calculating each patient's cumulative radiation dose and finding that children averaged four to six imaging tests that exposed them to radiation. Patients who were admitted after being brought to the emergency room had a higher average radiation exposure, averaging 18 mSv, while the average was 8 mSv for those sent home after emergency-room evaluation. The highest exposure was seen in children injured in car accidents, while the lowest was seen in burn patients. "In a trauma case, treatment decisions must be made in minutes, even seconds, and a CT scan can give a doctor invaluable information that could mean the difference between life and death," says lead investigator Marissa Brunetti, MD, a critical care specialist at the Johns Hopkins Children's Center. "But all we're saying here is, use CT scans and other radiation imaging tests sparingly and only when absolutely necessary, not as a diagnostic crutch. Ask yourself: Is another option, such as an ultrasound or careful observation, available?" The findings were presented at the 2009 Annual Meeting of the Pediatric Academic Societies, held May 2-5 in Baltimore, Maryland.
From "Doctors Should Minimize Scans That Expose Young Patients to Radiation"
InSciences.org (05/05/09)
Experts Advise Physicians Update Fee Schedules Every Three to 12 Months
Practice management experts recommend careful implementation and regular updating of doctors' fee schedules. They note that knowing when a discount is too deep has never been more critical now that self-pay patients are requesting breaks on their bills and health plans are publishing charge information and demanding ever-deeper discounts. Consultants advise physicians to be clearly aware of their breaking points even if they end up discounting from their fee schedule in nearly all instances. "The best defensible thing you do for your fee schedule is a cost study," says Evolution Healthcare's Susan Childs. The purpose of the study is to break down costs into work or hourly units and producing a list of services. Each service is assigned a portion of the practice's overhead cost as well as the margin and the actual cost of providing the service. Basing prices on costs plus margin ensures that the fee schedule is built on what the doctor requires to remain in business, not on what the doctor thinks sounds fair. Experts suggest that fee schedules get updated every three to 12 months. A defensible, carefully assembled, and updated fee schedule represents a starting point for health plan negotiations.
From "How to Set Your Fee Schedule: Experts Advise Updating It Every 3 to 12 Months"
American Medical News (05/04/09) Berry, Emily
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