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From RSNA
May RSNA News Now Online
The full version of the May issue of RSNA News is now available online.
Highlights include:
PET/CT May Improve Inflammatory Breast Cancer Prognosis
For patients diagnosed with inflammatory breast cancer (IBC), fluorodeoxyglucose (FDG) PET/CT may be helpful for staging the disease earlier than conventional imaging, according to a recent study.
Experts See Integration of Imaging Biomarkers by 2025
Experts who gathered for the second RSNA-sponsored Imaging Biomarker Roundtable crafted a vision for 2025 that includes establishing a valid and accurate collection of quantitative imaging biomarkers that are seamlessly integrated into clinical practice and trials.
Radiologists See Opportunity in Overuse of Back Imaging
A recently published metaanalysis that questions the value of lumbar spine imaging on some patients presents an opportunity for radiology to strengthen its role as imaging gatekeepers for referring physicians and patients.
Source Identified for Cancer Stem Cell Resistance to Radiation
One key to eradicating an entire tumor lies within its stem cells, according to a recent study that identified a source of cancer stem cell resistance to radiation and chemotherapy.
Academy of Radiology Research Adds New Focus
The new Academic Council formed by the Academy of Radiology Research (ARR) takes its mission to Capitol Hill this month, promoting the need for imaging research by bringing members of academic radiology departments face-to-face with their congressional representatives.
Leading the News
CMS Cites Inadequate Evidence in Decision Not to Expand Reimbursement for CTC Colorectal Cancer Screening
The Centers for Medicare and Medicaid Services (CMS) has issued a final decision that Medicare will not cover virtual colonoscopies. "The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under §1861(pp)(1) of the Social Security Act," says a memo released by CMS. "CT colonography for colorectal cancer screening remains noncovered." Despite public support for the coverage change, the reasoning behind the final decision reflects the agency's draft decision released in February. Of 357 public comments made on that draft decision during the 30-day comment period, only 16 agreed with the proposal to withhold reimbursement.
From "Decision Memo for Screening Computed Tomography Colonography (CTC) for Colorectal Cancer (CAG-00396N)"
Centers for Medicare & Medicaid Services (05/12/09)
Research
Radiation Alone Provides Similar Survival Rate to Chemoradiation in Patients With Inoperable, Locally Advanced NSCLC
According to a study presented at the European Multidisciplinary Conference in Thoracic Oncology (EMCTO) 2009 in Switzerland, patients with inoperable, locally advanced non-small-cell lung cancer (NSCLC) who cannot tolerate chemoradiation can have a similar survival rate with radiation alone. With this sort of NSCLC, induction chemotherapy before radical radiotherapy is indicated, but this may be problematic with patients who have significant comorbidities, decreased performance status, or advanced age. Researchers looked at 82 patients found able to tolerate chemoradiation, as well as 45 patients who were found unable to tolerate chemoradiation but had an Eastern Cooperative Oncology Group Performance Status greater than two. The chemoradiation-tolerant group was give two cycles of carboplatin on day one and vinorelbine on days one and eight, followed by computed tomography planned conformal radiotherapy of 55 Gy in 20 fractions and, based on tolerance, two further chemotherapy cycles. The non-tolerant group was given a radiotherapy dose of 55 Gy in 20 fractions. In the chemoradiation group, median survival was 554 days, while in the other group, median survival was 533 days, with no significant difference seen in a Chi-squared test analysis.
From "Radiation Alone Versus Sequential Chemoradiation Yields Comparable Survival in Patients With Inoperable, Locally Advanced NSCLC"
Doctor's Guide (05/07/09) Powers, Jenny
Technology
Researchers Develop Novel Radiolabeled Peptide
Researchers at the University of Virginia have found a new and highly potent Cu-labeled peptide that targets the formal peptide receptor on leukocytes. In a study of six mice that were administered Klebsiella pneumonia and four control mice, the researchers found that this radiolabeled peptide, targeting the formal peptide receptor, binds to neutrophils in vitro and accumulates at sites of inflammation in vivo. The researchers conclude that the peptide could be useful for investigating inflammation or injury.
From "A Novel Neutrophil-specific PET Imaging Agent"
Journal of Nuclear Medicine (05/09) Vol. 50, No. 5, P. 790; Locke, Landon W.; Chordia, Mahendra D.; Zhang, Yi; et al.
SIT Initiates Trial of Novel Imaging IT for MRI Review
The Silent Cerebral Infarct Multicenter Transfusion (SIT) Trial constitutes a multi-institutional intervention trial wherein children with silent cerebral infarcts are randomized to receive either blood transfusion therapy or observation for 36 months. The trial is slated to enroll some 1,880 children with sickle cell disease from 29 clinical sites in the United States, Canada, France, and Britain, and each child is subjected to a screening magnetic resonance imaging (MRI) of the brain to detect silent cerebral infarct-like lesions, a pre-randomization MRI, and exit MRI to ascertain the presence of new or enlarged cerebral infarcts via a designated, prospective imaging protocol. The goal of the researchers is to describe the technique to process and evaluate imaging studies for an international trial with a primary endpoint that includes neuroimaging. Investigators at each site received computer hardware and software for transmission of MRI images that permit them to delete all personal information from the scans and add unique study identifiers. A trio of neuroradiologists at separate academic centers review MRI studies and identify the presence or lack of silent cerebral infarct-like lesions. Their findings are subsequently placed on Web-based case report forms and routed to the Statistical Coordinating Center. It takes less than two working days, on average, for the local site to get the report from the radiology committee after receipt of the MRI study by the imaging center. This method maximizes efficiency and keeps the cost of a large multicenter trial that is heavily dependent on neuroimaging for entry criteria and assessment for the primary outcome measures to a minimum. The technology, process, and expertise used in the SIT Trial can be applied to virtually any clinical research trial with digital imaging requirements.
From "Silent Cerebral Infarct Transfusion (SIT) Trial Imaging Core: Application of Novel Imaging Information Technology for Rapid and Central Review of MRI"
Journal of Digital Imaging (06/09) Vol. 22, No. 3, P. 326; Vendt, Bruce A.; McKinstry, Robert C.; Ball, William S.; et al.
Medical-Legal Issues
CMS Initiates Comment Period for Expansion of FDG PET in the Treatment of Cervical Cancer
The Centers for Medicare and Medicaid Services (CMS) is reconsidering the national coverage determination (NCD) for FDG PET use in patients with cervical cancer. The current NCD covers FDG PET when it is used to guide the subsequent management of cervical cancer in women who have already undergone cancer treatment. It is also nationally covered as an adjunct test for the detection of pre-treatment metastasis in newly diagnosed cervical cancers following conventional imaging that is negative for extra-pelvic metastasis. However, all other Medicare coverage for uses of FDG PET related to cervical cancer is restricted to beneficiaries who are enrolled in a prospective clinical study under Coverage with Evidence Development. There has been a request to reconsider the NCD and nationally cover FDG PET more broadly, without the CED restriction. CMS will be accepting comments on this prospective change from May 8, 2009, until June 7, 2009. The agency is then expected to release a proposed decision memo on Nov. 8, 2009.
From "NCA Tracking Sheet for Positron Emission Tomography"
Centers for Medicare & Medicaid Services (05/08/09)
Lawmakers Mull Medical Device Safety Act
Lawmakers, including U.S. Rep. Bruce Braley (D-Iowa), discussed the merits of the Medical Device Safety Act of 2009 at a recent House Energy and Commerce Health Subcommittee hearing. The legislation would abolish the Supreme Court's ruling in 2008's Riegel vs. Medtronic case preventing injured patients from suing device manufacturers over FDA-approved products, which Braley said was flawed because it shifts the cost of caring for those patients from manufacturers to taxpayers. Rep. Steve Buyer (R-Ind.) opposes the bill. He argued that permitting patients to sue device makers in state courts would ultimately hinder device innovation and "force manufacturers to refuse to market their product in states that support patients' rights to sue device makers with FDA-approved products." This argument was countered by New England Journal of Medicine Executive Editor Gregory Curfman, who said that "innovation and patient safety are not mutually exclusive. We can and must have both."
From "Lawmakers Mull Medical Device Safety Act"
Modern Healthcare (05/12/09) Rhea, Shawn
Report Warns Medicare Will "Go Broke" in Eight Years Without Changes
Medicare will go broke in eight years if nothing is done to fix it because of the slowing economy and climbing healthcare costs, according to a new report by trustees for government-run entitlement programs. The report states that Medicare will run out of money in 2017, two years sooner than the last government projection. The report, which also warned about Social Security, says, "Medicare's financial difficulties come sooner—and are much more severe—than those confronting Social Security. ... Underlying healthcare costs per enrollee are projected to rise faster than the earnings per worker on which payroll taxes and Social Security benefits are based. As a result, while Medicare's annual costs were 3.2 percent of Gross Domestic Product (GDP) in 2008, or about three quarters of Social Security's, they are projected to surpass Social Security expenditures in 2028 and reach 11.4 percent of GDP in 2083." The report concludes that Medicare "cost growth can be contained without sacrificing quality of care only if healthcare cost growth more generally is contained. But despite the difficulties—indeed, because of the difficulties—it is essential that action be taken soon, particularly to control healthcare costs."
From "Status of the Social Security and Medicare Programs"
Social Security Online (05/13/09)
Clinical Practice
Experience Impacts Radiologists' Ability to Detect Coronary Stenoses
Prospectively assessing the impact of experience with coronary computed tomographic (CT) angiography on the ability to detect coronary stenoses of 50 percent or more was the goal of a study undertaken by a group of researchers. A trio of radiologists and one cardiologist inexperienced with coronary CT angiography attended an institution's cardiac CT unit for a 12-month fellowship, and they participated in the acquisition and reading of 12 to 15 coronary CT angiograms per week. Fellows independently read 50 CT angiographic test cases in patients who also underwent conventional coronary angiography in order to evaluate diagnostic performance progression. Between baseline and 12 months, two of the fellows showed significant improvement in sensitivity but not specificity, while one fellow exhibited the opposite. Three fellows significantly improved diagnostic odds ratios (DORs), while one fellow improved DOR, specificity, and sensitivity nonsignificantly. The study concluded that the diagnostic performance of inexperienced physicians improves with increasing experience, but obtaining expertise in coronary CT angiography may take longer than 12 months. The study appears in the May issue of Radiology.
From "Learning Curve for Coronary CT Angiography: What Constitutes Sufficient Training?"
Radiology Online (05/01/09) Vol. 251, P. 359; Pugliese, Francesca; Hunink, Myriam; Gruszczynska, Katarzyna; et al.
ARRA Funding Is Not Sufficient to Cover EHR Implementation
A PricewaterhouseCoopers Health Research Institute study finds that stimulus funds apportioned under the American Recovery and Reinvestment Act of 2009 (ARRA) will not be enough to fully cover the cost of implementing and maintaining electronic health records (EHRs) to hospitals and physician practices over the next five years. The federal government will pay individual physicians up to $44,000 to upgrade to EHRs under ARRA, but the PricewaterhouseCoopers report estimates that a three-doctor practice could pay as much as $296,000 for a complete EHR package. Starting in 2017, the government will lower Medicare payments to physicians who have not implemented EHRs by 1 percent per year for as many as five years. Hospitals could suffer even larger penalties because their health IT stimulus funding allotments for deployment would be based on their Medicare, Medicaid, and charity care volumes. "The penalties may be severe enough to motivate compliance with government-certified systems," notes the report. However, the study observes that "the purchase, deployment, and operation of an EHR may still be unaffordable [for some physician practices] because of the current cost of these systems and the lag between incentives and time of initial capital outlay."
From "Rock and a Hard Place: An Analysis of the $36 Billion Impact From Health IT Stimulus Funding"
PricewaterhouseCoopers News Release (05/13/09)
Mammogram Rates Seem to Be Slipping
A February study from the Centers for Disease Control and Prevention observed a "declining tendency" for women to have annual mammograms in nearly every U.S. state, and similar drop-offs were noted in recent years. "The 2010 target for all women, 70 percent, was met in 2000, but the proportion fell to 66 percent in 2005," reported National Cancer Institute researcher Stephen Taplin. The decline is a worrying issue for breast cancer experts, who note that mammograms can detect cancer early and reduce the risk of the disease spreading and eventually killing the patient. Women older than 40 are recommended to get a mammogram every one to two years by the U.S. Preventive Services Task Force, while the American Medical Association suggests a mammogram every year. Reasons for the decline include lingering uncertainty about whether a positive mammogram is likely to save a patient's life by having treatment administered immediately or to subject her to lengthy, painful, and possibly unnecessary therapies. "One thing we do know is that if women opt for mammograms, it does have to be done regularly, since they are of greatest value when physicians can compare changes that occur over time," said Taplin. Worries about pain, financial issues, and inconvenience are other factors underlying women's resistance to getting a mammogram, while some parts of the United States suffer from a shortage of places to have a mammogram because of a dearth of radiologists and technicians.
From "Mammogram Rates Seem to Be Slipping"
Washington Post (05/12/09) Kritz, Francesca Lunzer
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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